Gunda Bhavana, Strecker Sara E, Magaldi Robert J, Allen Donald A, Witmer Dan
University of Connecticut Medical School, Farmington, Connecticut.
Bone and Joint Institute, Hartford Hospital, Hartford, Connecticut.
J Arthroplasty. 2025 Jun 6. doi: 10.1016/j.arth.2025.06.007.
Total hip arthroplasty (THA) remains one of the most successful orthopaedic procedures to date, with about 90% of patients experiencing major improvements in pain and mobility. Despite its long-standing success, a subset of patients undergoing THA requires discharge to a skilled nursing facility (SNF). Preoperative resilience, assessed using the Brief Resilience Scale (BRS), may help to provide insights into which patients have poor outcomes.
This was a retrospective cohort study of 1,982 patients undergoing elective primary unilateral THA at a single institution from May 2020 to June 2023. Patients were stratified into three groups, low, average, and high resilience based on preoperatively assessed BRS: < 3, ≥ 3 and < 4.3, and ≥ 4.3, respectively. Demographic, clinical, and surgical parameters were analyzed alongside postoperative outcomes, including pain levels, opioid use, functional recovery, and discharge disposition. Logistic regression models assessed predictors of SNF discharge, with sensitivity and specificity evaluated using receiver operator characteristic analysis.
Patients who had low resilience (BRS < 3) were significantly more likely to require SNF discharge (16.2%) compared to those who had a BRS ≥ 4.3 (1.0%, P < 0.0001). These patients had longer hospital stays (P < 0.0001), shorter ambulation distances (P = 0.0051), and worse patient-reported outcomes overall. Univariate modeling using preoperative BRS and Risk Assessment and Prediction Tool scores, age, and postoperative physical therapy parameters was able to determine with 87.8% sensitivity and 96.9% specificity the probability of a SNF discharge.
Low preoperative resilience is strongly associated with poor postoperative outcomes following THA, including increased pain, delayed functional recovery, and SNF discharge. Incorporating BRS into preoperative assessments can improve patient stratification, assist in surgical planning, and guide interventions to enhance patients' postoperative trajectories. These findings support the integration of resilience-building strategies into perioperative care to optimize outcomes in this growing patient population.
III.
全髋关节置换术（THA）至今仍是最成功的骨科手术之一，约90%的患者在疼痛和活动能力方面有显著改善。尽管长期以来取得了成功，但接受THA的一部分患者需要出院后入住专业护理机构（SNF）。使用简短复原力量表（BRS）评估的术前复原力可能有助于深入了解哪些患者预后较差。
这是一项对2020年5月至2023年6月在单一机构接受择期初次单侧THA的1982例患者进行的回顾性队列研究。根据术前评估的BRS，患者被分为三组：低、中、高复原力组，分别为BRS < 3、≥ 3且< 4.3以及≥ 4.3。分析人口统计学、临床和手术参数以及术后结果，包括疼痛程度、阿片类药物使用情况、功能恢复和出院处置。逻辑回归模型评估SNF出院的预测因素，使用受试者工作特征分析评估敏感性和特异性。
与BRS≥4.3的患者（1.0%）相比，复原力低（BRS < 3）的患者更有可能需要入住SNF（16.2%，P < 0.0001）。这些患者住院时间更长（P < 0.0001），步行距离更短（P = 0.0051），总体患者报告的结果更差。使用术前BRS和风险评估与预测工具评分、年龄以及术后物理治疗参数进行单变量建模，能够以87.8%的敏感性和96.9%的特异性确定SNF出院的概率。
术前复原力低与THA术后不良结果密切相关，包括疼痛加剧、功能恢复延迟和入住SNF。将BRS纳入术前评估可以改善患者分层，协助手术规划，并指导干预措施以改善患者的术后进程。这些发现支持将复原力培养策略纳入围手术期护理，以优化这一不断增长的患者群体的治疗结果。
III级
