Harris Ian A, Peng Yi, Ackerman Ilana, Graves Stephen E
Ingham Institute for Applied Medical Research, School of Clinical Medicine, University of New South Wales, Medicine and Health, Liverpool, Australia.
Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, Australia.
JMIR Perioper Med. 2022 Jun 30;5(1):e33414. doi: 10.2196/33414.
Patient-reported outcome measures (PROMs) are commonly used to report outcomes after hip and knee arthroplasty, but response rates are rarely complete. Given that preoperative health status (as measured by PROMs) is a strong predictor of outcomes (using the same measures) and that these outcomes may influence the response rate, it is possible that postoperative response rates (the proportion of patients providing preoperative PROMs who also provide postoperative PROMs) may be influenced by preoperative health status.
This study aims to test the association between preoperative PROMs and postoperative response status following hip and knee arthroplasty.
Data from the PROMs program of the Australian national joint registry were used. The preoperative PROMs were the Oxford Hip Score or Oxford Knee Score, The EQ-5D Utility Index, and the EQ visual analog scale (VAS) for overall health. Logistic regression, adjusting for age, sex, BMI, and the American Society of Anesthesiologists (ASA) Physical Status Classification System, was used to test the association between each preoperative PROM and response status for the 6-month postsurgery survey.
Data from 9499 and 16,539 patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) for osteoarthritis, respectively, were included in the analysis. Adjusting for age, sex, BMI, and ASA, there was no significant difference in response status at the postoperative follow-up based on the preoperative Oxford Hip or Knee Scores (odds ratio [OR] 1.00, 95% CI 0.99-1.01 for both; P=.70 for THA and P=.85 for TKA). Healthier patients (based on the EQ VAS scores) preoperatively were more likely to respond postoperatively, but this difference was negligible (OR 1.00, 95% CI 1.00-1.01 for THA and TKA; P=.004 for THA and P<.001 for TKA). The preoperative EQ Utility Index was not associated with the postoperative response rate for THA (OR 1.14, 95% CI 0.96-1.36; P=.13) or TKA patients (OR 1.05, 95% CI 0.91-1.22; P=.49).
The likelihood of responding to a postoperative PROMs survey for patients undergoing hip or knee arthroplasty was not associated with clinically important differences in preoperative patient-reported joint pain, function, or health-related quality of life. This suggests that the assessment of postoperative outcomes in hip and knee arthroplasty is not biased by differences in preoperative health measures between responders and nonresponders.
患者报告结局测量指标（PROMs）常用于报告髋关节和膝关节置换术后的结局，但应答率很少能达到100%。鉴于术前健康状况（通过PROMs测量）是结局（使用相同测量指标）的有力预测因素，且这些结局可能影响应答率，术后应答率（提供术前PROMs且也提供术后PROMs的患者比例）可能受术前健康状况影响。
本研究旨在检验髋关节和膝关节置换术后术前PROMs与术后应答状态之间的关联。
使用澳大利亚国家关节注册中心PROMs项目的数据。术前PROMs为牛津髋关节评分或牛津膝关节评分、EQ-5D效用指数以及整体健康状况的EQ视觉模拟量表（VAS）。采用多因素logistic回归分析，对年龄、性别、体重指数（BMI）和美国麻醉医师协会（ASA）身体状况分类系统进行校正，以检验每项术前PROM与术后6个月调查应答状态之间的关联。
分析纳入了分别接受择期全髋关节置换术（THA）和全膝关节置换术（TKA）治疗骨关节炎的9499例和16539例患者的数据。校正年龄、性别、BMI和ASA后，基于术前牛津髋关节或膝关节评分，术后随访时的应答状态无显著差异（THA和TKA的优势比[OR]均为1.00，95%置信区间[CI]均为0.99 - 1.01；THA的P = 0.70，TKA的P = 0.85）。术前健康状况较好的患者（基于EQ VAS评分）术后更有可能做出应答，但这种差异可忽略不计（THA和TKA的OR均为1.00，95% CI均为1.00 - 1.01；THA的P = 0.004，TKA的P < 0.001）。术前EQ效用指数与THA患者（OR = 1.14，95% CI = 0.96 - 1.36；P = 0.13）或TKA患者（OR = 1.05，95% CI = 0.91 - 1.22；P = 0.49）的术后应答率无关。
接受髋关节或膝关节置换术的患者对术后PROMs调查做出应答的可能性与术前患者报告的关节疼痛、功能或健康相关生活质量的临床重要差异无关。这表明髋关节和膝关节置换术后结局的评估不会因应答者和非应答者术前健康测量指标的差异而产生偏差。
