Gunda Bhavana, Strecker Sara, Magaldi Robert James, Allen Donald A, Witmer Dan
From the Department of Orthopedics, University of Connecticut Medical School, Farmington, CT (Dr. Gunda); the Bone and Joint Institute Hartford Hospital, Hartford, CT (Dr. Strecker, Dr. Allen, and Dr. Witmer); the Division of Orthopaedic Surgery, Jefferson Health, Stratford, NJ (Dr. Magaldi); and the Orthopedic Associates of Hartford, Hartford, CT (Dr. Allen and Dr. Witmer).
J Am Acad Orthop Surg Glob Res Rev. 2025 Aug 19;9(8). doi: 10.5435/JAAOSGlobal-D-25-00068. eCollection 2025 Aug 1.
The incidence of total knee arthroplasty (TKA), an effective orthopaedic procedure for end-stage osteoarthritis, is increasing substantially. The shift toward performing this procedure in the outpatient setting necessitates precise patient selection criteria to ensure optimal postoperative outcomes. This study examines the predictive value of preoperative patient-reported outcome measures (PROMs), including the Brief Resilience Scale (BRS), in determining candidacy for outpatient TKA.
A retrospective analysis of 2,167 patients undergoing elective primary, unilateral TKA from May 2020 to June 2023 was conducted. Preoperative PROMs, including Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR), Patient-Reported Outcomes Measurement Information System (PROMIS)-10, Risk Assessment and Prediction Tool (RAPT), and BRS, were collected. Patients were stratified into three groups by BRS score: low (BRS score < 3), average (BRS score ≥ 3 and < 4.3), and high (BRS score ≥ 4.3) resilience. Length of stay (LOS), discharge disposition, and complications were assessed postoperatively. Logistic regression and receiver operative characteristic (ROC) curve analyses were used to assess the predictive validity of PROMs for discharge to a skilled nursing facility (SNF) in conjunction with extended LOS.
Patients with low resilience (BRS score < 3) were found to have a significantly higher likelihood of discharge to a SNF and extended LOS compared with the other two groups (11.5% vs. 1.6%, P < 0.001). Logistic regression demonstrated that BRS, RAPT, and PROMIS-10 scores were also notable predictors, with a combined model predicting an extended LOS and discharge to SNF with 82.4% sensitivity and 79.9% specificity.
Preoperative PROMs such as BRS can serve as a valuable tool in predicting the failure of outpatient TKA. Incorporating preoperative PROMs into presurgical decision making can enhance patient selection for ambulatory procedures and improve surgical outcomes. Additional prospective studies are warranted to validate these findings within other elective surgical populations and to determine how to best modify resilience.
全膝关节置换术（TKA）是治疗终末期骨关节炎的一种有效骨科手术，其发病率正在大幅上升。在门诊环境中开展该手术的转变需要精确的患者选择标准，以确保术后获得最佳效果。本研究探讨术前患者报告结局指标（PROMs），包括简易复原力量表（BRS），在确定门诊TKA候选资格方面的预测价值。
对2020年5月至2023年6月期间接受择期初次单侧TKA的2167例患者进行回顾性分析。收集术前PROMs，包括关节置换的膝关节损伤和骨关节炎结局评分（KOOS，JR）、患者报告结局测量信息系统（PROMIS）-10、风险评估与预测工具（RAPT）和BRS。根据BRS评分将患者分为三组：低复原力（BRS评分<3）、中等复原力（BRS评分≥3且<4.3）和高复原力（BRS评分≥4.3）。术后评估住院时间（LOS）、出院处置情况和并发症。采用逻辑回归和受试者工作特征（ROC）曲线分析来评估PROMs对出院至专业护理机构（SNF）并伴有延长LOS的预测有效性。
与其他两组相比，低复原力（BRS评分<3）的患者出院至SNF和延长LOS的可能性显著更高（11.5%对1.6%，P<0.001）。逻辑回归表明，BRS、RAPT和PROMIS-10评分也是显著的预测指标，联合模型预测延长LOS和出院至SNF的敏感性为82.4%，特异性为79.9%。
术前PROMs如BRS可作为预测门诊TKA失败的有价值工具。将术前PROMs纳入术前决策可优化门诊手术的患者选择并改善手术效果。需要更多前瞻性研究在其他择期手术人群中验证这些发现，并确定如何最好地改善复原力。
