Musgrave Park Hospital, Belfast, UK.
Royal Infirmary of Edinburgh, Edinburgh, UK.
Bone Joint J. 2023 Jul 1;105-B(7):783-794. doi: 10.1302/0301-620X.105B7.BJJ-2023-0078.R1.
The aim of this study was to report health-related quality of life (HRQoL) and joint-specific function in patients waiting for total hip or knee arthroplasty surgery (THA or TKA) in Northern Ireland, compared to published literature and a matched normal population. Secondary aims were to report emergency department (ED) and out-of-hours general practitioner (OOH GP) visits, new prescriptions of strong opioids, and new prescriptions of antidepressants while waiting.
This was a cohort study of 991 patients on the waiting list for arthroplasty in a single Northern Ireland NHS trust: 497 on the waiting list for ≤ three months; and 494 waiting ≥ three years. Postal surveys included the EuroQol five-dimension five-level questionnaire (EQ-5D-5L), visual analogue scores (EQ-VAS), and Oxford Hip and Knee scores to assess HRQoL and joint-specific function. Electronic records determined prescriptions since addition to the waiting list and patient attendances at OOH GP/EDs.
Overall, 712/991 (71.8%) responded at ≤ three months for THA (n = 164) and TKA (n = 199), and ≥ three years for THA (n = 88) and TKA (n = 261). The median EQ-5D-5L score in those waiting ≤ three months was 0.155 (interquartile range (IQR) -0.118 to 0.375) and 0.189 (IQR -0.130 to 0.377) for ≥ three years. Matched controls had a median EQ-5D-5L 0.837 (IQR 0.728 to 1.000). Compared to matched controls, EQ-5D-5L scores were significantly lower in both waiting cohorts (p < 0.001) with significant differences found in every domain. Negative scores, indicating a state "worse than death", were present in 40% at ≤ three months and 38% at ≥ three years. Patients waiting ≥ three years had significantly more opioid (28.4% vs 15.2%; p < 0.001) and antidepressant prescriptions (15.2% vs 9.9%; p = 0.034) and significantly more joint-related attendances at unscheduled care (11.7% vs 0% with ≥ one ED attendance (p < 0.001) and (25.5% vs 2.5% ≥ one OOH GP attendance (p < 0.001)).
Patients on waiting lists in Northern Ireland are severely disabled with the worst HRQoL and functional scores studied. The lack of deterioration in EQ-5D-5L and joint-specific scores between patients waiting ≤ three months and ≥ three years likely reflects floor effects of these scores. Prolonged waits were associated with increased dependence on strong opiates, depression, and attendances at unscheduled care.
本研究旨在报告北爱尔兰等待全髋关节或全膝关节置换术（THA 或 TKA）的患者的健康相关生活质量（HRQoL）和关节特异性功能，并与已发表的文献和匹配的正常人群进行比较。次要目的是报告急诊（ED）和非工作时间全科医生（OOH GP）就诊、新开具强阿片类药物处方和新开具抗抑郁药处方的情况。
这是一项对北爱尔兰单一国民保健服务信托中等待关节置换手术的 991 名患者的队列研究：497 名患者在等待名单上的时间≤3 个月；494 名患者等待时间≥3 年。邮寄问卷调查包括欧洲五维健康量表 5 级问卷（EQ-5D-5L）、视觉模拟评分（EQ-VAS）和牛津髋关节和膝关节评分，以评估 HRQoL 和关节特异性功能。电子记录确定了自加入等待名单以来的处方和患者在 OOH GP/ED 的就诊情况。
总体而言，在 THA（n=164）和 TKA（n=199）等待≤3 个月的患者中，有 712/991（71.8%）在≤3 个月时和≥3 年时的 THA（n=88）和 TKA（n=261）进行了回复。在等待≤3 个月的患者中，中位数 EQ-5D-5L 评分为 0.155（四分位距[IQR]为 0.118-0.375），等待≥3 年的患者为 0.189（IQR 为 0.130-0.377）。匹配对照组的中位数 EQ-5D-5L 为 0.837（IQR 为 0.728-1.000）。与匹配对照组相比，等待队列的 EQ-5D-5L 评分均显著降低（p<0.001），每个领域均存在显著差异。负分表示“比死亡更糟糕”的状态，在等待≤3 个月的患者中占 40%，在等待≥3 年的患者中占 38%。等待≥3 年的患者显著更多地开具了阿片类药物（28.4% vs 15.2%；p<0.001）和抗抑郁药（15.2% vs 9.9%；p=0.034），并且在非计划性护理就诊中显著更多地与关节相关（11.7% vs 0%，至少有一次 ED 就诊（p<0.001）和（25.5% vs 2.5%，至少有一次 OOH GP 就诊（p<0.001））。
北爱尔兰等待名单上的患者存在严重的残疾，研究中表现出最差的 HRQoL 和功能评分。在等待≤3 个月和≥3 年的患者之间，EQ-5D-5L 和关节特异性评分没有恶化，这可能反映了这些评分的下限效应。等待时间延长与对强阿片类药物、抑郁和非计划性护理就诊的依赖增加有关。
