Vickery Nicola J, Fowler Alexander J, Prowle John, Pearse Rupert
CCPMG, William Harvey Research Institute, Queen Mary University of London, London, UK.
CCPMG, William Harvey Research Institute, Queen Mary University of London, London, UK.
Br J Anaesth. 2025 Jan;134(1):203-211. doi: 10.1016/j.bja.2024.08.037. Epub 2024 Nov 13.
Total hip replacement surgery is performed to improve quality of life (QoL). We explored the association between multimorbidity and change in QoL after total hip replacement.
Analysis of patients included in the NHS England hip replacement Patient Reported Outcome Measures (PROMs) database with complete preoperative from 3 to 6 months postoperative EQ-5D QoL data from April 2013 to March 2018. Multimorbidity was defined as two or more chronic diseases excluding arthritis. The primary outcome measure was change in QoL using the Pareto Classification of Health Change. We compared QoL change for patients with and without multimorbidity and those with no multimorbidity using multivariable modelling. Data are presented as odds ratio (OR) with 95% confidence interval or n (%).
Of 216,191 patients, we included 178,129 (82.4%) patients with complete data. Most patients 63,327 (35.6%) were 70-79 yr of age, and 98,513 (55.3%) were women. Multimorbidity was present in 38,384 patients (21.6%). QoL improved after surgery for 149,774 (84.1%) patients, remained unchanged for 10,219 (5.7%) patients, and became worse after surgery for 7289 (4.1%) patients. QoL changes were mixed (at least one QoL domain improved and at least one deteriorated) for 10,847 (6.1%) patients. Poor QoL outcomes (unchanged/mixed/worse) were more likely for patients with multimorbidity (OR 1.53 [1.49-1.58]).
Hip replacement surgery improves QoL. However, patients with multimorbidity are less likely to experience these benefits. Poor QoL outcomes became more frequent as the number of comorbid diseases increased. These data should inform shared decision-making conversations around joint replacement surgery.
全髋关节置换手术旨在改善生活质量（QoL）。我们探讨了多种疾病并存与全髋关节置换术后生活质量变化之间的关联。
对纳入英格兰国民医疗服务体系（NHS）髋关节置换患者报告结局测量（PROMs）数据库的患者进行分析，这些患者在2013年4月至2018年3月期间有完整的术前至术后3至6个月的EQ-5D生活质量数据。多种疾病并存定义为除关节炎外的两种或更多种慢性疾病。主要结局指标是使用健康变化的帕累托分类法来衡量生活质量的变化。我们使用多变量模型比较了有和没有多种疾病并存的患者以及没有多种疾病并存的患者的生活质量变化。数据以比值比（OR）及95%置信区间或n（%）表示。
在216,191例患者中，我们纳入了178,129例（82.4%）有完整数据的患者。大多数患者63,327例（35.6%）年龄在70 - 79岁之间，98,513例（55.3%）为女性。38,384例患者（21.6%）存在多种疾病并存情况。149,774例（84.1%）患者术后生活质量改善，10,219例（5.7%）患者保持不变，7289例（4.1%）患者术后生活质量变差。10,847例（6.1%）患者的生活质量变化呈混合状态（至少一个生活质量领域改善且至少一个恶化）。多种疾病并存的患者更有可能出现较差的生活质量结局（不变/混合/变差）（OR 1.53 [1.49 - 1.58]）。
髋关节置换手术可改善生活质量。然而，但多种疾病并存的患者不太可能体验到这些益处。随着合并疾病数量的增加，较差的生活质量结局变得更加频繁。这些数据应为围绕关节置换手术的共同决策对话提供参考。
