Self-reported allergies correlate with a worse patient-reported outcome after hip arthroscopy: a matched control study

Abstract

Patient-reported outcome measures (PROMs) in patients with and without at least one self-reported allergy undergoing hip arthroscopy were compared. Data on 1434 cases were retrospectively reviewed, and 267 patients were identified with at least one self-reported allergy and randomly matched to a control group on a 1:2 ratio. Four PROMs [Modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports (HOS-Sport) and 33-item International Hip Outcome Tool (iHOT-33)] were collected preoperatively, and at 5–11, 12–23 and 24–35 months postoperatively. Significant PROM differences were found 5–11 months postoperative on mHHS (P < 0.001), HOS-ADL (P = 0.002), HOS-Sport (P < 0.001) and iHOT-33 (P < 0.001). At 12–23 months postoperative, the allergy cohort had significantly worse scores on mHHS (P = 0.002), HOS-ADL (P = 0.001), HOS-Sport (P < 0.001) and iHOT-33 (P < 0.001). They also had significantly worse measures 24–35 months postoperative on mHHS (P = 0.019), HOS-Sport (P = 0.006) and iHOT-33 (P < 0.001). Multivariable logistic regression showed that each additional allergy reported significantly increased the risk of failing to meet the minimal clinically important difference 5–11 months after surgery on mHHS by 1.15 [OR (95% CI): 1.15 (1.03, 1.30), P = 0.014], on HOS-ADL by 1.16 [OR (95% CI): 1.16 (1.02, 1.31), P = 0.021] and on iHOT-33 by 1.20 [OR (95% CI): 1.20 (1.07, 1.36), P = 0.002]. Results suggest self-reported allergies increase the likelihood of a patient-perceived worse outcome after hip arthroscopy. An understanding of this association by the physician is essential during presurgical planning and in the management of postoperative care.

The predictive value of self-reported allergies for reoperation after index hip arthroscopy

“…Ultimately, a reasonable conclusion that can be inferred from the above findings is that allergy status should be considered in the context of multiple patient-specific factors that influence arthroscopic outcomes. Based on the results in this study, as well as the results of prior investigations [ 14 , 18 ], it is evident that allergy status is linked to arthroscopic outcome. However, this association is complex in nature and likely reflects the impact of various psychosomatic factors on arthroscopic outcomes.…”

“…Studies have shown that self-reported allergies associate with pre-existing psychiatric conditions and prognosticate risk of developing mood and anxiety disorders in the future [ 16 , 30 ]. This association may explain the results of the present study and similar investigations because psychological factors can influence the postoperative course and compromised mental wellness increases the likelihood of inferior patient-reported outcomes [ 14 , 18 , 31 , 32 ]. Further, preoperative mental health conditions associated with reduced postoperative hip function and poor surgical outcomes [ 15 , 17 , 33 ].…”

“…It is worthwhile to consider the reoperation rate in the allergy cohort in this study along with the patient-reported outcomes published in other investigations. Research has shown considerable intra-group improvement from baseline PROM scores and high achievement rates of the MCID in allergy cohorts despite inferior results when compared to the outcomes of a control group [ 10 , 18 ]. Thus, a clinician should be cautious when extrapolating data about mental health and/or allergy status toward arthroscopic outcome given the notable improvements many of these patients report from their baseline state.…”

“…Allergy status was ascertained retrospectively after being documented at the time of presentation in an electronic medical record. This presents a possible confounding variable as prior studies have shown that allergies can sometimes be recorded incorrectly or absently [ 14 , 18 ]. Another limitation was the discrepancy between cohorts regarding age and sex.…”

Increasing patient-reported allergies are not associated with pain, functional outcomes, or satisfaction following medial patellofemoral ligament reconstruction: a retrospective comparative cohort study

“…conducted a retrospective analysis that found that THA and TKA patients with a higher number of PRAs had a higher risk for prosthetic joint infection (PJI) [ 6 ]. Similar negative associations between PRAs and outcomes have been found for other orthopedic procedures such as spine surgery and hip arthroscopy [ 7 , 21 ].…”