Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia; Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Osteoarthritis Cartilage. 2021 Sep;29(9):1275-1281. doi: 10.1016/j.joca.2021.06.009. Epub 2021 Jul 2.
The primary aim of this study was to evaluate the agreement between surgeons and two validated total knee arthroplasty (TKA) appropriateness tools, and secondarily to compare Australian appropriateness rates to those reported internationally.
A consecutive sample of patients from one public hospital arthroplasty clinic and a convenience sample from private rooms of surgeons in New South Wales, Australia (n = 11), referred for surgical opinion regarding TKA were enrolled over 1 year. Surgeons applied appropriateness tools created by Escobar et al. and the American Academy of Orthopaedic Surgeons (AAOS). Correlation between the appropriateness tools and surgeon's decisions were evaluated.
There were 368 patients enrolled, and contrasting rates of being "appropriate" for surgery were identified between the Escobar (n = 109, 29.6%) and AAOS (n = 292, 79.3%) tools. Surgeon agreement with the Escobar tool was substantial (ĸ = 0.61, 95%CI: 0.53-0.69) compared to slight with the AAOS tool (ĸ = 0.11, 95%CI: 0.06-0.16). Of those advised against TKA (n = 179, 48.6%), the AAOS tool suggested many patients (n = 111, 62.0%) were "appropriate" compared to the Escobar tool (n = 12, 6.7%).
Surgeons rated patients seeking opinion for TKA as appropriate over half the time, however the AAOS tool had low correlation with surgeons as opposed to the Escobar tool. This was illustrated by both tools rating a majority of patients to be operated on as appropriate, but only the AAOS tool considering most patients not chosen for surgery to be appropriate. When comparing previously published appropriateness rates, appropriateness in Australia, USA, Spain and Qatar was found to be similar.
本研究的主要目的是评估外科医生与两种经过验证的全膝关节置换术（TKA）适宜性工具之间的一致性，并次要比较澳大利亚的适宜率与国际报道的结果。
本研究纳入了 1 年内来自澳大利亚新南威尔士州一家公立医院关节置换诊所的连续样本患者和外科医生私人诊室的方便样本患者（n=11），这些患者因 TKA 手术建议而接受评估。外科医生应用了由 Escobar 等人和美国矫形外科医师学会（AAOS）创建的适宜性工具。评估了适宜性工具与外科医生决策之间的相关性。
共纳入 368 例患者，Escobar 工具（n=109，29.6%）和 AAOS 工具（n=292，79.3%）确定的手术“适宜”率存在差异。外科医生与 Escobar 工具的一致性较高（ĸ=0.61，95%CI：0.53-0.69），而与 AAOS 工具的一致性较低（ĸ=0.11，95%CI：0.06-0.16）。在建议不进行 TKA 的患者中（n=179，48.6%），AAOS 工具提示许多患者（n=111，62.0%）为“适宜”，而 Escobar 工具提示为（n=12，6.7%）。
外科医生评估接受 TKA 手术建议的患者有一半以上的时间被认为是适宜的，然而，与 Escobar 工具相比，AAOS 工具与外科医生的相关性较低。这两种工具都表明大多数患者被认为适合手术，但只有 AAOS 工具认为大多数未选择手术的患者适合手术。在比较以前发表的适宜率时，发现澳大利亚、美国、西班牙和卡塔尔的适宜率相似。
