Heath Emma L, Ackerman Ilana N, Holder Carl, Lorimer Michelle F, Graves Stephen E, Harris Ian A
South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
ANZ J Surg. 2022 Sep;92(9):2229-2234. doi: 10.1111/ans.17811. Epub 2022 May 31.
Total hip replacement (THR) and total knee replacement (TKR) are cost-effective interventions to reduce pain and disability associated with osteoarthritis, however there is no clear guidelines available to determine appropriate patient selection and the timing of surgery. This prospective cohort study aimed to evaluate the hospital- and surgeon-level variation in the severity of patient-reported symptoms prior to THR and TKR.
Patients undergoing primary THR (n = 4330) or TKR (n = 7054) for osteoarthritis who participated in a national registry-led Patient Reported Outcome Measures (PROMs) pilot program were included in the analysis. Pre-operative Oxford Hip Score (OHS) and Oxford Knee Score (OKS) (range 0-48; representing worst to best hip/knee pain and function) data were examined for variation between private and public hospitals and between surgeons using linear mixed models.
Pre-operative mean OHS was significantly higher (better) in patients whose surgery was performed in a private hospital compared to public hospitals; 21.39 versus 18.11 (mean difference 3.27, 95% CI 1.75, 4.79). For OKS, the difference between private hospital and public hospital scores was dependent on BMI and gender. Most of the variation in pre-operative OHS and OKS was not at the individual hospital- or surgeon-level, which explained only a negligible proportion of the model variance (⟨5%) for THR and TKR.
Apart from a difference between private and public hospitals, there was little between-hospital or between-surgeon symptom variation in joint-specific pain and function prior to THR or TKR. The findings suggest consistency in the surgical thresholds for patients being offered hip and knee joint replacement procedures.
全髋关节置换术（THR）和全膝关节置换术（TKR）是减轻骨关节炎相关疼痛和残疾的经济有效的干预措施，然而目前尚无明确的指南来确定合适的患者选择和手术时机。这项前瞻性队列研究旨在评估全髋关节置换术和全膝关节置换术前患者报告症状严重程度在医院和外科医生层面的差异。
分析了参与一项由国家登记处主导的患者报告结局测量（PROMs）试点项目、因骨关节炎接受初次全髋关节置换术（n = 4330）或全膝关节置换术（n = 7054）的患者。使用线性混合模型检查私立医院和公立医院之间以及外科医生之间术前牛津髋关节评分（OHS）和牛津膝关节评分（OKS）（范围0 - 48；代表最差到最佳的髋关节/膝关节疼痛和功能）数据的差异。
与公立医院相比，在私立医院接受手术的患者术前平均OHS显著更高（更好）；分别为21.39和18.11（平均差异3.27，95%CI 1.75，4.79）。对于OKS，私立医院和公立医院评分之间的差异取决于体重指数（BMI）和性别。术前OHS和OKS的大部分差异并非在个别医院或外科医生层面，这仅解释了全髋关节置换术和全膝关节置换术模型方差的可忽略不计的比例（<5%）。
除了私立医院和公立医院之间的差异外，在全髋关节置换术或全膝关节置换术前，特定关节疼痛和功能在医院之间或外科医生之间的症状差异很小。研究结果表明在为患者提供髋关节和膝关节置换手术的手术阈值方面具有一致性。
