Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom.
Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Bristol, United Kingdom.
PLoS One. 2021 Dec 31;16(12):e0261850. doi: 10.1371/journal.pone.0261850. eCollection 2021.
Identify risk factors for poor pain outcomes six months after primary knee replacement surgery.
Observational cohort study on patients receiving primary knee replacement from the UK Clinical Practice Research Datalink, Hospital Episode Statistics and Patient Reported Outcomes. A wide range of variables routinely collected in primary and secondary care were identified as potential predictors of worsening or only minor improvement in pain, based on the Oxford Knee Score pain subscale. Results are presented as relative risk ratios and adjusted risk differences (ARD) by fitting a generalized linear model with a binomial error structure and log link function.
Information was available for 4,750 patients from 2009 to 2016, with a mean age of 69, of whom 56.1% were female. 10.4% of patients had poor pain outcomes. The strongest effects were seen for pre-operative factors: mild knee pain symptoms at the time of surgery (ARD 18.2% (95% Confidence Interval 13.6, 22.8), smoking 12.0% (95% CI:7.3, 16.6), living in the most deprived areas 5.6% (95% CI:2.3, 9.0) and obesity class II 6.3% (95% CI:3.0, 9.7). Important risk factors with more moderate effects included a history of previous knee arthroscopy surgery 4.6% (95% CI:2.5, 6.6), and use of opioids 3.4% (95% CI:1.4, 5.3) within three months after surgery. Those patients with worsening pain state change had more complications by 3 months (11.8% among those in a worse pain state vs. 2.7% with the same pain state).
We quantified the relative importance of individual risk factors including mild pre-operative pain, smoking, deprivation, obesity and opioid use in terms of the absolute proportions of patients achieving poor pain outcomes. These findings will support development of interventions to reduce the numbers of patients who have poor pain outcomes.
确定初次膝关节置换术后六个月疼痛结局不良的危险因素。
对英国临床实践研究数据库、医院发病统计数据和患者报告结局中接受初次膝关节置换的患者进行观察性队列研究。根据牛津膝关节评分疼痛子量表，确定了广泛的常规收集于初级和二级保健中的变量，作为疼痛恶化或仅有轻微改善的潜在预测因子。通过拟合具有二项误差结构和对数链接函数的广义线性模型，以相对风险比和调整风险差异（ARD）呈现结果。
2009 年至 2016 年期间，4750 名患者的信息可用，平均年龄 69 岁，其中 56.1%为女性。10.4%的患者疼痛结局不良。术前因素的影响最大：手术时轻度膝关节疼痛症状（ARD 18.2%（95%置信区间 13.6，22.8））、吸烟 12.0%（95%CI：7.3，16.6）、居住在最贫困地区 5.6%（95%CI：2.3，9.0）和肥胖 II 级 6.3%（95%CI：3.0，9.7）。具有更中度影响的重要危险因素包括既往膝关节镜手术史 4.6%（95%CI：2.5，6.6）和术后三个月内使用阿片类药物 3.4%（95%CI：1.4，5.3）。疼痛状态变化的患者在 3 个月时出现更多并发症（疼痛状态恶化的患者中为 11.8%，疼痛状态相同的患者中为 2.7%）。
我们根据达到疼痛结局不良的患者比例，量化了个体危险因素（包括术前轻度疼痛、吸烟、贫困、肥胖和阿片类药物使用）的相对重要性。这些发现将支持开发干预措施以减少疼痛结局不良的患者数量。
