Mehta Nabil, Lavoie-Gagne Ophelie Z, Diaz Connor C, Cohn Matthew R, Garrigues Grant E, Nicholson Gregory P, Verma Nikhil N, Forsythe Brian
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
JSES Int. 2022 Aug 17;6(6):903-909. doi: 10.1016/j.jseint.2022.08.001. eCollection 2022 Nov.
The purpose of this investigation was to determine the effect of travel distance on achieving the minimal clinically important difference (MCID) on all three commonly used patient-reported outcome measures (PROMs) for the shoulder more than 1 year following total shoulder arthroplasty (TSA).
Patients undergoing reverse or anatomic TSA at a high-volume tertiary referral center between September 2016 and August 2018 were retrospectively reviewed. Patients were divided into 2 groups: driving distance of >50 miles from the location of surgery (referral group) and driving distance of <50 miles (local group). Scores on preoperative and postoperative PROMs, including American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, and Constant Score (CS) at minimum 1-year follow-up were assessed. Chi-square analysis was used to analyze the achievement of MCID on any PROM or a combination of PROMs. Logistic regression was performed to determine whether travel distance and other variables of interest had an effect on achieving MCID on all three PROMs.
A total of 214 patients with minimum 1-year follow-up were included in the final analysis. Of these, 165 patients (77.1%) traveled <50 miles to their orthopedic provider at the time of surgery. The local group demonstrated significantly inferior preoperative SANE scores ( < .001) and significantly higher postoperative ASES scores ( = .001). A total of 166 (77%) patients achieved all three MCIDs postoperatively. There was no significant difference between distance groups for achievement of all MCIDs ( = .328). On multivariable regression, body mass index > 30 (odds ratio [OR], 5.78; 95% confidence interval [CI], 1.53-30.28), worker's compensation status (OR, 16.78; 95% CI, 2.34-161.39), and higher preoperative ASES score (OR, 1.04; 95% CI, 1.01-1.07) were associated with an increased risk of failure to achieve all MCIDs ( < .05). Age, adjusted gross income, private insurance, and travel distance were not significantly associated with failure to achieve all MCIDs.
After controlling for age, sex, and adjusted gross income, distance traveled to a high-volume referral center did not have an effect on achieving the MCID on all three commonly used PROMs for the shoulder at least 1 year after undergoing TSA. Elevated body mass index, worker's compensation status, and higher preoperative ASES score were associated with an increased risk of failure to achieve all MCIDs after TSA.
本研究的目的是确定在全肩关节置换术（TSA）后1年以上，出行距离对三种常用的肩关节患者报告结局测量指标（PROMs）达到最小临床重要差异（MCID）的影响。
回顾性分析2016年9月至2018年8月在一家大型三级转诊中心接受反向或解剖型TSA的患者。患者分为两组：手术地点出行距离>50英里（转诊组）和出行距离<50英里（本地组）。评估术前和术后PROMs的评分，包括美国肩肘外科医师（ASES）评分、单评估数字评价（SANE）评分和至少1年随访时的常数评分（CS）。采用卡方分析来分析在任何一项PROM或多项PROM组合上达到MCID的情况。进行逻辑回归分析以确定出行距离和其他感兴趣的变量是否对在所有三项PROMs上达到MCID有影响。
共有214例至少随访1年的患者纳入最终分析。其中，165例患者（77.1%）手术时到骨科医生处的出行距离<50英里。本地组术前SANE评分显著更低（<0.001），术后ASES评分显著更高（=0.001）。共有166例（77%）患者术后达到了所有三项MCID。在所有MCID的达成情况上，距离组之间无显著差异（=0.328）。在多变量回归分析中，体重指数>30（比值比[OR]，5.78；95%置信区间[CI]，1.53 - 30.28）、工伤赔偿状态（OR，16.78；95%CI，2.34 - 161.39）以及术前ASES评分更高（OR，1.04；95%CI，1.01 - 1.07）与未达到所有MCID的风险增加相关（<0.05）。年龄、调整后总收入、私人保险和出行距离与未达到所有MCID无显著关联。
在控制年龄、性别和调整后总收入后，前往大型转诊中心的出行距离对TSA术后至少1年在三种常用的肩关节PROMs上达到MCID没有影响。体重指数升高、工伤赔偿状态以及术前ASES评分更高与TSA术后未达到所有MCID的风险增加相关。
