Miura Takanori, Kijima Hiroaki, Konishi Natsuo, Kubota Hitoshi, Yamada Shin, Tazawa Hiroshi, Tani Takayuki, Suzuki Norio, Kamo Keiji, Fujii Masashi, Sasaki Ken, Kawano Tetsuya, Iwamoto Yosuke, Nagahata Itsuki, Miyakoshi Naohisa, Shimada Yoichi
Department of Orthopedic Surgery, Kakunodate General Hospital, 3 Iwase, Kakunodate, Senboku, Akita, 014-0394, Japan.
Akita Hip Research Group (AHRG), 1-1-1 Hondo, Akita, 010-8543, Japan.
J Orthop. 2020 Dec 30;23:78-82. doi: 10.1016/j.jor.2020.12.028. eCollection 2021 Jan-Feb.
Although the reported clinical outcomes of total hip arthroplasty (THA) for hip osteoarthritis are satisfactory, not all patients are completely satisfied. Thus, there is interest in predicting postoperative satisfaction before surgery. The influence of comorbidities and preoperative medications on the incidence of complications and duration of hospitalization following THA has become apparent. However, studies about the associations of preoperative medication with clinical outcomes of THA are limited. Therefore, this study aimed to clarify the relationship between preoperative medications and postoperative patient-reported outcomes. This retrospective cross-sectional multicenter study enrolled post-THA patients (79 patients, 90 hips) who were examined from February to March 2019 in eight general hospitals. Outcome measures included patient-reported outcome as Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) score. Preoperative medications were investigated from medical records. Medications were categorized, and analgesics were categorized into non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, pregabalin, duloxetine, neurotropin (an extract from inflammatory rabbit skin inoculated by vaccinia virus), and opioid. To identify the factors associated with JHEQ score, the patients were divided into lower (<55 score) and higher (≥55) JHEQ score groups. Spearman rank correlation coefficient (r) showed significant difference between the total number of preoperative medications and postoperative JHEQ movement subscale (r = -0.37, p < 0.01), mental subscale (r = -0.29, p < 0.01), and JHEQ (r = -0.30, p < 0.01) scores. In the multiple logistic regression analysis, only the total number of preoperative medications was identified as a risk factor for lower JHEQ score (p < 0.01). This study clarified an inverse correlation between the total preoperative medication count and postoperative outcomes and found that larger total count of preoperative medications is a risk factor of poor postoperative patient-reported outcomes of THA.
尽管报道的全髋关节置换术（THA）治疗髋关节骨关节炎的临床结果令人满意，但并非所有患者都完全满意。因此，人们对术前预测术后满意度很感兴趣。合并症和术前用药对THA术后并发症发生率和住院时间的影响已很明显。然而，关于术前用药与THA临床结果之间关联的研究有限。因此，本研究旨在阐明术前用药与术后患者报告结局之间的关系。这项回顾性横断面多中心研究纳入了2019年2月至3月在八家综合医院接受检查的THA术后患者（79例患者，90髋）。结局指标包括患者报告结局，即日本骨科协会髋关节疾病评估问卷（JHEQ）评分。从病历中调查术前用药情况。对药物进行分类，镇痛药分为非甾体抗炎药（NSAIDs）、对乙酰氨基酚、普瑞巴林、度洛西汀、神经妥乐平（一种由牛痘病毒接种的炎性兔皮提取物）和阿片类药物。为了确定与JHEQ评分相关的因素，将患者分为JHEQ评分较低（<55分）和较高（≥55分）的组。Spearman等级相关系数（r）显示术前用药总数与术后JHEQ运动亚量表（r = -0.37，p < 0.01）、心理亚量表（r = -0.29，p < 0.01）及JHEQ（r = -0.30，p < 0.01）评分之间存在显著差异。在多因素logistic回归分析中，仅术前用药总数被确定为JHEQ评分较低的危险因素（p < 0.01）。本研究阐明了术前用药总数与术后结局之间的负相关关系，并发现术前用药总数较多是THA术后患者报告结局较差的危险因素。
