全髋关节置换术后患者报告结局现状及影响因素分析
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摘要
目的:了解全髋关节置换术患者术后3个月患者报告结局的现状并探讨其影响因素。方法:采用横断面调查,选取2016年5月至2016年10月行全髋关节置换术的患者。应用"髋关节功能障碍和骨性关节炎评分-简体中文版"等测量全髋关节置换术后患者报告结局,并分析其个人因素、疾病相关因素以及术前期望等因素是否对其造成影响。Excel录入数据,SPSS19.0进行统计分析,选用t检验等行单因素分析,多元线性回归行多因素分析。结果:纳入全髋关节置换术后患者共326例,其术后3个月患者报告结局得分为(372.05±54.79)分;通过多元线性回归分析,发现:术后疗效满意度(β=58.837,95%CI=54.773～61.958,P=0.000)、年龄(β=-0.928,95%CI=-0.992～-0.575,P=0.000)、出院后依从性(β=9.749,95%CI=6.008～11.827,P=0.000)、术后是否有并发症(β=-13.968,95%CI=-17.211～-8.123,P=0.000)、出院时患者报告结局得分(β=0.174,95%CI=0.064～0.224,P=0.002)、出院后是否有非计划再入院(β=-27.514,95%CI=-37.446～-17.702,P=0.002)、术前疼痛评分(β=-1.506,95%CI=-2.368～-0.639,P=0.034)和术前期望康复时间(β=1.905,95%CI=1.257～3.347,P=0.036)是全髋关节置换术后患者报告结局的影响因素,回归方程决定系数R2=0.661。结论:应高度重视入院时疼痛程度重、高龄、术前期望值高、术后发生并发症、术后疗效不满意、术后存在非计划再入院以及出院时患者报告结局得分较低者,并加强住院期间有效干预及出院后延续性护理。
Objectives:To acknowledge the patient reported outcomes of total hip arthroplasty 3 months after surgery and analyze the influencing factors. Methods:The cross-sectional study was adopted to select the patients undergoing total hip arthroplasty from May2016 to October 2016. The "Simplified Chinese version of Hip dysfunction and Osteoarthritis Outcome Score"was used to measure the patient reported outcomes. And then the possible influencing factors,such as individual characteristics were analyzed,for which,the data input was done with Excel,statistical analysis with SPSS 19.0,single factor analysis with t test and multi-factor analysis with multiple linear regression. Results:A total of 326 patients were enrolled in the study and the score of patient reported outcomes was(372.05±54.79)3 months after surgery. The multiple linear regression analysis found that the influencing factors included the postoperative satisfaction of therapeutic effects(β=58.837,95%CI=54.773 to 61.958,P=0.000),age(β=-0.928,95%CI=-0.992 to-0.575,P=0.000),compliance(β=9.749,95%CI=6.008 to 11.827,P=0.000),postoperative complication(β=-13.968,95%CI=-17.211 to-8.123,P=0.000),the patient reported outcomes score at discharge(β=0.174,95%CI=0.064 to 0.224,P=0.002),unplanned readmission(β=-27.514,95%CI=-37.446 to-17.702,P=0.002),the degree of preoperative pain(β=-1.506,95%CI=-2.368 to-0.639,P=0.034)and preoperative expectations for recovery time(β=1.905,95%CI=1.257 to 3.347,P=0.036). And the determination coefficient of regression equation was R2=0.661. Conclusion:The high attention should be paid to the patients with severe preoperative pain,older ages,high preoperative expectation,postoperative complication,dissatisfaction with therapeutic effects,unplanned readmission,and the lower patient reported outcomes score at discharge. And the effective intervention for these patients while in hospital and the continued care after discharge should be strengthened.
Objectives:To acknowledge the patient reported outcomes of total hip arthroplasty 3 months after surgery and analyze the influencing factors. Methods:The cross-sectional study was adopted to select the patients undergoing total hip arthroplasty from May2016 to October 2016. The "Simplified Chinese version of Hip dysfunction and Osteoarthritis Outcome Score"was used to measure the patient reported outcomes. And then the possible influencing factors,such as individual characteristics were analyzed,for which,the data input was done with Excel,statistical analysis with SPSS 19.0,single factor analysis with t test and multi-factor analysis with multiple linear regression. Results:A total of 326 patients were enrolled in the study and the score of patient reported outcomes was(372.05±54.79)3 months after surgery. The multiple linear regression analysis found that the influencing factors included the postoperative satisfaction of therapeutic effects(β=58.837,95%CI=54.773 to 61.958,P=0.000),age(β=-0.928,95%CI=-0.992 to-0.575,P=0.000),compliance(β=9.749,95%CI=6.008 to 11.827,P=0.000),postoperative complication(β=-13.968,95%CI=-17.211 to-8.123,P=0.000),the patient reported outcomes score at discharge(β=0.174,95%CI=0.064 to 0.224,P=0.002),unplanned readmission(β=-27.514,95%CI=-37.446 to-17.702,P=0.002),the degree of preoperative pain(β=-1.506,95%CI=-2.368 to-0.639,P=0.034)and preoperative expectations for recovery time(β=1.905,95%CI=1.257 to 3.347,P=0.036). And the determination coefficient of regression equation was R2=0.661. Conclusion:The high attention should be paid to the patients with severe preoperative pain,older ages,high preoperative expectation,postoperative complication,dissatisfaction with therapeutic effects,unplanned readmission,and the lower patient reported outcomes score at discharge. And the effective intervention for these patients while in hospital and the continued care after discharge should be strengthened.
引文
[1] Charnley J. Arthroplasty of the hip. A new operation[J]. Lancet,1961,277(7187):1129-1132.
[2] Memtsoudis SG,Pumberger M,Ma Y,et al. Epidemiology and risk factors for perioperative mortality after total hip and knee arthroplasty[J].J Orthop Res,2012,30(11):1811-1821.
[3] Harris WH,Sledge CB. Total hip and total knee replacement[J]. N Engl J Med,1990,323(11):725-731.
[4] Pivec R,Johnson AJ,Mears SC,et al. Hip arthroplasty[J]. Lancet,2012,380(9855):1768-1777.
[5] Lee CE,Simmonds MJ,Novy DM,et al. Self-reports and clinicianmeasured physical function among patients with low back pain:a comparison[J]. Arch Phys Med Rehabil,2001,82(2):227-231.
[6] Bostrm C. Shoulder rotational strength,movement,pain and joint tenderness as indicators of upper-extremity activity limitation in moderate rheumatoid arthritis[J]. Scand J Rehabil Med,2000,32(3):134-139.
[7] Fortin PR,Clarke AE,Joseph L,et al. Outcomes of total hip and knee replacement:preoperative functional status predicts outcomes at six months after surgery[J]. Arthritis Rheum,1999,42(8):1722-1728.
[8] Leong KP,Chong EY,Kong KO,et al. Discordant assessment of lupus activity between patients and their physicians:the Singapore experience[J]. Lupus,2010,19(1):100-106.
[9] Janse AJ,Gemke RJ,Uiterwaal CS,et al. Quality of life:patients and doctors don’t always agree:a meta-analysis[J]. J Clin Epidemiol,2004,57(7):653-661.
[10] U.S. Department of Health and Human Services FDA Center for Drug Evaluation and Research,U.S. Department of Health and Human Services FDA Center for Biologics Evaluation and Research,U.S. Department of Health and Human Services FDA Center for Devices and Radiological Health. Guidance for industry:patient-reported outcome measures:use in medical product development to support labeling claims:draft guidance[J]. Health Qual Life Outcomes,2006,4:79.
[11] Wei X,Wang Z,Yang C,et al. Development of a simplified Chinese version of the hip disability and osteoarthritis outcome score(HOOS):cross-cultural adaptation and psychometric evaluation[J]. Osteoarthritis and Cartilage,2012,20(12):1563-1567.
[12] Thorborg K,Roos E,Bartels E,et al. Validity,reliability and responsiveness of patient-reported outcome questionnaires when assessing hip and groin disability:a systematic review[J]. Br J Sports Med,2010,44(16):1186-1196.
[13] Mikkelsen LR,Mechlenburg I,Sballe K,et al. Effect of early supervised progressive resistance training compared to unsupervised home-based exercise after fast-track total hip replacement applied to patients with preoperative functional limitations. A single-blinded randomised controlled trial[J]. Osteoarthritis Cartilage,2014,22(12):2051-2058.
[14] Duivenvoorden T,Vissers MM,Verhaar JA,et al. Anxiety and depressive symptoms before and after total hip and knee arthroplasty:a prospective multicentre study[J]. Osteoarthritis Cartilage,2013,21(12):1834-1840.
[15] Waheeb A,Zywiel MG,Palaganas M,et al. The influence of patient factors on patient-reported outcomes of orthopedic surgery involving implantable devices:a systematic review[J]. Semin Arthritis Rheum,2015,44(4):461-471.
[16] Singh JA,Lewallen DG. Medical comorbidity is associated with persistent index hip pain after total hip arthroplasty[J]. Pain Med,2013,14(8):1222-1229.
[17] Waljee J,McGlinn EP,Sears ED,et al. Patient expectations and patient-reported outcomes in surgery:a systematic review[J]. Surgery,2014,155(5):799-808.
[18] Paxton EW,Inacio MC,Khatod M,et al. Risk calculators predict failures of knee and hip arthroplasties:findings from a large health maintenance organization[J]. Clin Orthop Relat Res,2015,473(12):3965-3973.
[19] Judge A,Batra R,Beard D,et al. Identifying predictors of patient reported outcomes of primary hip replacement surgery:a multi-centre population based cohort study[J]. Osteoarthritis and Cartilage,2011,19(s1):21-22.
[20] Smith GH,Johnson S,Ballantyne JA,et al. Predictors of excellent early outcome after total hip arthroplasty[J]. J Orthop Surg Res,2012,7:13.
[21] Lungu E,Vendittoli PA,Desmeules F. Identification of patients with suboptimal results after hip arthroplasty:development of a preliminary prediction algorithm[J]. BMC Musculoskelet Disord,2015,16(5):279.
[22] Judge A,Javaid MK,Arden NK,et al. Clinical tool to identify patients who are most likely to achieve long-term improvement in physical function after total hip arthroplasty[J]. Arthritis Care Res(Hoboken),2012,64(6):881-889.
[23] Davis AM,Agnidis Z,Badley E,et al. Predictors of functional outcome two years following revision hip arthroplasty[J]. J Bone Joint Surg Am,2006,88(4):685-691.
[24] Quintana JM,Escobar A,Aguirre U,et al. Predictors of healthrelated quality-of-life change after total hip arthroplasty[J]. Clin Orthop Relat Res,2009,467(11):2886-2894.
[25] Oliver RL. A Cognitive Model of the Antecedents and Consequences of Satisfaction Decisions[J]. Journal of Marketing Research,1980,17(4):460.
[26] Anakwe RE,Jenkins PJ,Moran M. Predicting dissatisfaction after total hip arthroplasty:a study of 850 patients[J]. J Arthroplasty,2011,26(2):209-213.
[27] Hamilton DF,Lane JV,Gaston P,et al. What determines patient satisfaction with surgery? A prospective cohort study of 4709 patients followingtotal joint replacement[J]. BMJ Open,2013,3(4):e002525.
[2] Memtsoudis SG,Pumberger M,Ma Y,et al. Epidemiology and risk factors for perioperative mortality after total hip and knee arthroplasty[J].J Orthop Res,2012,30(11):1811-1821.
[3] Harris WH,Sledge CB. Total hip and total knee replacement[J]. N Engl J Med,1990,323(11):725-731.
[4] Pivec R,Johnson AJ,Mears SC,et al. Hip arthroplasty[J]. Lancet,2012,380(9855):1768-1777.
[5] Lee CE,Simmonds MJ,Novy DM,et al. Self-reports and clinicianmeasured physical function among patients with low back pain:a comparison[J]. Arch Phys Med Rehabil,2001,82(2):227-231.
[6] Bostrm C. Shoulder rotational strength,movement,pain and joint tenderness as indicators of upper-extremity activity limitation in moderate rheumatoid arthritis[J]. Scand J Rehabil Med,2000,32(3):134-139.
[7] Fortin PR,Clarke AE,Joseph L,et al. Outcomes of total hip and knee replacement:preoperative functional status predicts outcomes at six months after surgery[J]. Arthritis Rheum,1999,42(8):1722-1728.
[8] Leong KP,Chong EY,Kong KO,et al. Discordant assessment of lupus activity between patients and their physicians:the Singapore experience[J]. Lupus,2010,19(1):100-106.
[9] Janse AJ,Gemke RJ,Uiterwaal CS,et al. Quality of life:patients and doctors don’t always agree:a meta-analysis[J]. J Clin Epidemiol,2004,57(7):653-661.
[10] U.S. Department of Health and Human Services FDA Center for Drug Evaluation and Research,U.S. Department of Health and Human Services FDA Center for Biologics Evaluation and Research,U.S. Department of Health and Human Services FDA Center for Devices and Radiological Health. Guidance for industry:patient-reported outcome measures:use in medical product development to support labeling claims:draft guidance[J]. Health Qual Life Outcomes,2006,4:79.
[11] Wei X,Wang Z,Yang C,et al. Development of a simplified Chinese version of the hip disability and osteoarthritis outcome score(HOOS):cross-cultural adaptation and psychometric evaluation[J]. Osteoarthritis and Cartilage,2012,20(12):1563-1567.
[12] Thorborg K,Roos E,Bartels E,et al. Validity,reliability and responsiveness of patient-reported outcome questionnaires when assessing hip and groin disability:a systematic review[J]. Br J Sports Med,2010,44(16):1186-1196.
[13] Mikkelsen LR,Mechlenburg I,Sballe K,et al. Effect of early supervised progressive resistance training compared to unsupervised home-based exercise after fast-track total hip replacement applied to patients with preoperative functional limitations. A single-blinded randomised controlled trial[J]. Osteoarthritis Cartilage,2014,22(12):2051-2058.
[14] Duivenvoorden T,Vissers MM,Verhaar JA,et al. Anxiety and depressive symptoms before and after total hip and knee arthroplasty:a prospective multicentre study[J]. Osteoarthritis Cartilage,2013,21(12):1834-1840.
[15] Waheeb A,Zywiel MG,Palaganas M,et al. The influence of patient factors on patient-reported outcomes of orthopedic surgery involving implantable devices:a systematic review[J]. Semin Arthritis Rheum,2015,44(4):461-471.
[16] Singh JA,Lewallen DG. Medical comorbidity is associated with persistent index hip pain after total hip arthroplasty[J]. Pain Med,2013,14(8):1222-1229.
[17] Waljee J,McGlinn EP,Sears ED,et al. Patient expectations and patient-reported outcomes in surgery:a systematic review[J]. Surgery,2014,155(5):799-808.
[18] Paxton EW,Inacio MC,Khatod M,et al. Risk calculators predict failures of knee and hip arthroplasties:findings from a large health maintenance organization[J]. Clin Orthop Relat Res,2015,473(12):3965-3973.
[19] Judge A,Batra R,Beard D,et al. Identifying predictors of patient reported outcomes of primary hip replacement surgery:a multi-centre population based cohort study[J]. Osteoarthritis and Cartilage,2011,19(s1):21-22.
[20] Smith GH,Johnson S,Ballantyne JA,et al. Predictors of excellent early outcome after total hip arthroplasty[J]. J Orthop Surg Res,2012,7:13.
[21] Lungu E,Vendittoli PA,Desmeules F. Identification of patients with suboptimal results after hip arthroplasty:development of a preliminary prediction algorithm[J]. BMC Musculoskelet Disord,2015,16(5):279.
[22] Judge A,Javaid MK,Arden NK,et al. Clinical tool to identify patients who are most likely to achieve long-term improvement in physical function after total hip arthroplasty[J]. Arthritis Care Res(Hoboken),2012,64(6):881-889.
[23] Davis AM,Agnidis Z,Badley E,et al. Predictors of functional outcome two years following revision hip arthroplasty[J]. J Bone Joint Surg Am,2006,88(4):685-691.
[24] Quintana JM,Escobar A,Aguirre U,et al. Predictors of healthrelated quality-of-life change after total hip arthroplasty[J]. Clin Orthop Relat Res,2009,467(11):2886-2894.
[25] Oliver RL. A Cognitive Model of the Antecedents and Consequences of Satisfaction Decisions[J]. Journal of Marketing Research,1980,17(4):460.
[26] Anakwe RE,Jenkins PJ,Moran M. Predicting dissatisfaction after total hip arthroplasty:a study of 850 patients[J]. J Arthroplasty,2011,26(2):209-213.
[27] Hamilton DF,Lane JV,Gaston P,et al. What determines patient satisfaction with surgery? A prospective cohort study of 4709 patients followingtotal joint replacement[J]. BMJ Open,2013,3(4):e002525.
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