Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
Division of Healthcare Policy & Research, Department of Health Sciences Research, Rochester, MN.
J Arthroplasty. 2021 Jun;36(6):1958-1965. doi: 10.1016/j.arth.2021.01.043. Epub 2021 Jan 22.
The purpose of this study was to investigate whether patient-reported knee function and health status before and after primary total knee replacement (TKR) at an academic medical center differs among patients from diverse geographic regions.
We assessed patient-reported outcomes (PROs) as measured by the Oxford Knee Score (OKS) and EuroQoL-5D (EQ-5D) in 2855 TKR patients at preprimary and one year postprimary TKR procedure between January 1, 2012 and June 30, 2014. We compared the demographic characteristics, response rates, and changes in OKS, EQ-5D, and EQ visual analog scale among local, regional, and national patient groups. Patient- or hospital-related predictors of the postoperative scores were identified after controlling for preoperative scores on the PRO measures.
Local patients had more comorbid conditions. Groups were similar in clinical outcomes such as length of stay at hospital, complication, and reoperation rates. Local, regional, and national patients had similar response rates and reported a similar level of knee function and health-related quality of life before and after TKR. Eighty nine percent had clinically important improvement on OKS, 69% on EQ-5D index, and 28% EQ visual analog scale, and there were no differences among groups in the proportions of clinically meaningful change. Better postoperative PRO scores were associated with older age, shorter hospital stay, fewer comorbidities, nonsmoking status, fewer complications, and private health insurance.
Some patient characteristics such as comorbidities were greater in the local patient cohort versus the national cohort. Nevertheless, clinical outcomes and PROs were comparable across all geographic tiers.
本研究旨在探讨在学术医疗中心行初次全膝关节置换术（TKR）前后，来自不同地理区域的患者的膝关节功能和健康状况自评是否存在差异。
我们评估了 2012 年 1 月 1 日至 2014 年 6 月 30 日期间，2855 例初次 TKR 患者在 TKR 术前和术后 1 年的牛津膝关节评分（OKS）和欧洲五维健康量表（EQ-5D）等患者报告的结局（PRO）。我们比较了本地、区域和全国患者组的人口统计学特征、应答率，以及 OKS、EQ-5D 和 EQ 视觉模拟量表的变化。在控制 PRO 测量的术前评分后，确定了患者或医院相关的术后评分预测因素。
本地患者合并症更多。各组在住院时间、并发症和再次手术率等临床结局方面相似。本地、区域和全国患者的应答率相似，TKR 前后膝关节功能和健康相关生活质量报告水平相似。89%的患者 OKS 有临床意义的改善，69%的患者 EQ-5D 指数有临床意义的改善，28%的患者 EQ 视觉模拟量表有临床意义的改善，各组间有临床意义的变化比例无差异。术后 PRO 评分更好与年龄较大、住院时间较短、合并症较少、不吸烟、并发症较少和私人医疗保险有关。
与全国患者队列相比，本地患者队列的某些患者特征（如合并症）更为严重。尽管如此，所有地理层次的临床结局和 PRO 均具有可比性。
