Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Commonwealth University, Richmond, Virginia.
Arthritis Care Res (Hoboken). 2023 May;75(5):1132-1139. doi: 10.1002/acr.24961. Epub 2022 Dec 23.
Expected outcomes (e.g., expected survivorship after a cancer treatment) have improved decision-making around treatment options in many clinical fields. Our objective was to evaluate the effect of expected values of 3 widely available total knee arthroplasty (TKA) outcomes (risk of serious complications, time to revision, and improvement in pain and function at 2 years after surgery) on clinical recommendation of TKA.
The RAND/University of California Los Angeles appropriateness criteria method was used to evaluate the role of the 3 expected outcomes in clinical recommendation of TKA. The expected outcomes were added to 5 established preoperative factors from the modified Escobar appropriateness criteria. The 8 indication factors were used to develop 279 clinical scenarios, and a panel of 9 clinicians rated the appropriateness of TKA for each scenario as inappropriate, inconclusive, and appropriate. Classification tree analysis was applied to these ratings to identify the most influential of the 8 factors in discriminating TKA appropriateness classifications.
Ratings for the 279 appropriateness scenarios deemed 34.4% of the scenarios as appropriate, 40.1% as inconclusive, and 25.5% as inappropriate. Classification tree analyses showed that expected improvement in pain and function and expected time to revision were the most influential factors that discriminated among the TKA appropriateness classification categories.
Our results showed that clinicians would use expected postoperative outcome factors in determining appropriateness for TKA. These results call for further work in this area to incorporate estimates of expected pain/function and revision outcomes into clinical practice to improve decision-making for TKA.
在许多临床领域，预期结果（例如癌症治疗后的预期生存率）改善了治疗方案的决策。我们的目的是评估 3 种广泛可用的全膝关节置换术（TKA）结果（严重并发症风险、翻修时间和术后 2 年疼痛和功能改善）的预期值对 TKA 临床推荐的影响。
使用 RAND/加州大学洛杉矶分校适宜性标准方法评估 3 种预期结果在 TKA 临床推荐中的作用。将预期结果添加到改良 Escobar 适宜性标准的 5 个术前因素中。这 8 个指征因素用于制定 279 个临床场景，由 9 名临床医生组成的小组对每个场景进行 TKA 的适宜性评估，结果分为不适当、不确定和适当。分类树分析应用于这些评分，以确定 8 个因素中哪些因素对区分 TKA 适宜性分类最具影响力。
对 279 个适宜性场景的评分中，34.4%的场景被认为是适当的，40.1%的场景是不确定的，25.5%的场景是不适当的。分类树分析显示，预期的疼痛和功能改善以及预期的翻修时间是区分 TKA 适宜性分类的最具影响力的因素。
我们的研究结果表明，临床医生将在确定 TKA 的适宜性时使用预期的术后结果因素。这些结果呼吁在该领域进一步开展工作，将预期的疼痛/功能和翻修结果纳入临床实践，以改善 TKA 的决策。
