Atsma Femke, Molenkamp Olivier, Bouma Heinse, Bolder Stefan B, Groenewoud A Stef, Westert Gert P
Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Geert Grooteplein Noord 21, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
Quin, Willem Fenengastraat 17, 1096 BL, Amsterdam, The Netherlands.
Int J Qual Health Care. 2021 Mar 4;33(1). doi: 10.1093/intqhc/mzab030.
Uniform criteria for performing hip replacement surgery in hip osteoarthritis patients are currently lacking. As a result, variation in surgery and inappropriateness of care may occur. The aim of this study was to develop a consensus-based decision tool to support the decision-making process for hip replacement surgery.
Patients with a diagnosis of unilateral or bilateral osteoarthritis were included. Consensus rounds with orthopedic surgeons were organized to blindly reassess medical files and to decide whether surgery is indicated or not, based on all available pre-treatment information. We compared the outcomes obtained from the blind reassessment by the consensus group with the actual treatment. Furthermore, prediction models were fitted on the reassessment outcome to identify which set of clinical parameters would be most predictive and uniformly shared in the decision to operate.Two prediction models were fitted, one model without radiologic outcomes and one model where radiologic outcomes were included.
In total, 364 medical files of osteoarthritis patients were included and reassessed in the analyses. Key predictors in the prediction model without radiology were age, flexion, internal rotation and the Hip disability and Osteoarthritis Outcome Score-quality of life. The discriminative power was high (Area Under Receiver Operating Curve (AUC) = 0.86). Key predictors in the prediction model with radiology were age, internal rotation and Kellgren and Lawrence severity score (AUC = 0.94).
The study yielded a decision tool with uniform criteria for hip replacement surgery in osteoarthritis patients. The tool will guide the clinical decision-making process of physicians on whether to perform hip surgery and should be used together with information about patient preferences and social context.
目前，髋骨关节炎患者进行髋关节置换手术缺乏统一标准。因此，可能会出现手术差异和护理不当的情况。本研究的目的是开发一种基于共识的决策工具，以支持髋关节置换手术的决策过程。
纳入诊断为单侧或双侧骨关节炎的患者。组织骨科医生进行共识会议，以盲目重新评估病历，并根据所有可用的治疗前信息决定是否需要进行手术。我们将共识小组盲目重新评估的结果与实际治疗结果进行了比较。此外，对重新评估结果进行预测模型拟合，以确定哪一组临床参数在手术决策中最具预测性且能统一共享。拟合了两个预测模型，一个模型不包括放射学结果，另一个模型包括放射学结果。
分析共纳入并重新评估了364例骨关节炎患者的病历。无放射学结果的预测模型中的关键预测因素是年龄、屈曲、内旋以及髋关节残疾和骨关节炎结果评分-生活质量。判别力较高（受试者操作特征曲线下面积（AUC）=0.86）。有放射学结果的预测模型中的关键预测因素是年龄、内旋以及凯尔格伦和劳伦斯严重程度评分（AUC=0.94）。
该研究产生了一种用于骨关节炎患者髋关节置换手术的具有统一标准的决策工具。该工具将指导医生关于是否进行髋关节手术的临床决策过程，并且应与患者偏好和社会背景信息一起使用。
