Wang Cheng-Chi, Huang Kui-Chou, Ku Ming-Chou, Pan Chien-Chou, Hsieh Cheng-Pu, Chang Ing-Lin, Tzeng Chung-Yuh, Chen Chao-Ping, Lee Yung-Heng, Chen Yen-Jen, Tsai Yi-Shiun, Kung Pei-Tseng, Chou Wen-Yu, Tsai Wen-Chen
Department of Public Health, China Medical University, Taichung, Taiwan.
Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.
Sci Rep. 2024 Dec 3;14(1):30028. doi: 10.1038/s41598-024-81852-7.
This study aimed to investigate the factors influencing the decision of patients with severe knee osteoarthritis, who are covered by universal health insurance, to undergo total knee replacement (TKR) surgery, as recommended by orthopedic physicians. A questionnaire survey was used to collect participants' demographics, socio-economic status, medical history, baseline Oxford Knee Score (OKS), and EuroQol-5 Dimension Questionnaire (EQ-5D). We included 704 patients with severe knee osteoarthritis, of which 487 underwent TKR (surgery group), while 217 did not (non-surgery group). Descriptive statistics was used to compare the characteristics of patients in the two groups, while logistic regression identified the factors influencing patients' choice for TKR. Patients aged 75-79 or older were less likely to undergo TKR; those with poorer OKS (OR = 0.83, 95% CI: 0.79-0.86) and lower EQ-5D VAS scores (OR = 0.97, 95% CI: 0.95-0.99) were more likely to undergo TKR. Household income did not significantly affect the decision of the patients to undergo surgery. In conclusion, for patients with severe knee osteoarthritis, the impact of joint discomfort on function and quality of life is the primary factor influencing their decision to undergo TKR, while economic factors do not have a significant impact under the provision of universal health insurance coverage.
本研究旨在调查在全民健康保险覆盖下，患有重度膝骨关节炎的患者按照骨科医生建议接受全膝关节置换术（TKR）手术的决策影响因素。采用问卷调查收集参与者的人口统计学信息、社会经济状况、病史、基线牛津膝关节评分（OKS）和欧洲五维健康量表问卷（EQ-5D）。我们纳入了704例重度膝骨关节炎患者，其中487例接受了TKR手术（手术组），而217例未接受手术（非手术组）。采用描述性统计比较两组患者的特征，同时使用逻辑回归确定影响患者选择TKR的因素。年龄在75 - 79岁及以上的患者接受TKR手术的可能性较小；OKS评分较差（OR = 0.83，95%CI：0.79 - 0.86）和EQ-5D视觉模拟量表（VAS）得分较低（OR = 0.97，95%CI：0.95 - 0.99）的患者更有可能接受TKR手术。家庭收入对患者的手术决策没有显著影响。总之，对于重度膝骨关节炎患者，关节不适对功能和生活质量的影响是影响其接受TKR手术决策的主要因素，而在全民健康保险覆盖的情况下，经济因素没有显著影响。
