The impact of preoperative patient characteristics on health states after total hip replacement and related satisfaction thresholds: a cohort study

Abstract

BackgroundThe aim of the study was to analyze the effect of preoperative patient characteristics on health outcomes 6 months after total hip replacement (THR), to support patient’s decision making in daily practice with predicted health states and satisfaction thresholds. By giving incremental effects for different patient subgroups, we support comparative effectiveness research (CER) on osteoarthritis interventions.MethodsIn 2012, 321 patients participated in health state evaluation before and 6 months after THR. Health-related quality of life (HRQoL) was measured with the EQ-5D questionnaire. Hip-specific pain, function, and mobility were measured with the WOMAC in a prospective observation of a cohort. The predictive capability of preoperative patient characteristics – classified according to socio-demographic factors, medical factors, and health state variables – for changes in health outcomes is tested by correlation analysis and multivariate linear regressions. Related satisfaction thresholds were calculated with the patient acceptable symptom state (PASS) concept.ResultsThe mean WOMAC and EQ-5D scores before operation were 52 and 60 respectively (0 worst, 100 best). At the 6-month follow-up, scores improved by 35 and 19 units. On average, patients reported satisfaction with the operation if postoperative (change) WOMAC scores were higher than 85 (32) and postoperative (change) EQ-5D scores were higher than 79 (14).ConclusionsChanges in WOMAC and EQ-5D scores can mainly be explained by preoperative scores. The lower the preoperative WOMAC or EQ-5D scores, the higher the change in the scores. Very good or very poor preoperative scores lower the probability of patient satisfaction with THR. Shared decision making using a personalized risk assessment approach provides predicted health states and satisfaction thresholds.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-014-0108-1) contains supplementary material, which is available to authorized users.

Clinical improvement and satisfaction after total joint replacement: a prospective 12-month evaluation on the patients’ perspective

“…A clear dependency of satisfaction and WOMAC scores on the baseline status has been shown before with higher baseline scores yielding in higher PASS cutoffs [41,42]. In another investigation including 321 THA patients with baseline WOMAC scores comparable to those in the present study (i.e., 52 points), the PASS threshold at 6 months has been indicated with 85 points [43], matching the value we found at the same time point. Somewhat surprisingly, no effect of baseline scores on PASS thresholds at 1 year after THA was found by Paulsen et al [44] for the HOOS and EQ-5D, but these authors indicated gender and age effects.…”

“…They reported a 1-year PASS of 0.92 for the EQ-5D index [44], the similar value we found in the present investigation. Vogl and associates indicated a 6-month PASS for the EQ-5D VAS of 79 that is well transferrable to the value 0.76 we found for the EQ-5D index at 6 months since both subscales are highly correlated with each other [43]. It seems therefore that different PROMs are more prone to be dependent on the preoperative patient status than others.…”

Informação Como Instrumento Da Assistência Ao Paciente Submetido a Cirurgia Ortopédica

“…Várias informações fundamentais relacionadas ao período pré-operatório não foram citadas pelos indivíduos pesquisados, tais como: informações sobre tipo e tempo de manutenção da prótese; risco da cirurgia e possíveis complicações; restrições e limitações relacionadas à cirurgia; consentimento para a cirurgia; problemas e intervenções relacionados com ansiedade, medo, distúrbios do sono; estímulo ao autocuidado dentro das limitações do paciente; cuidados gerais de Enfermagem e de prevenção da síndrome do desuso; medicamentos específicos para problemas identificados e alterações de esquemas terapêuticos cotidianos; realização de exames laboratoriais e por imagem; avaliação pré-operatória pelo enfermeiro do Centro Cirúrgico (6,(13)(14)(15)(16)(17)(18)(19)(20) .…”

“…Além desses, também foram omitidos: riscos relacionados à anestesia; informações sobre o protocolo de cirurgia segura; necessidade de suporte social; cuidados e restrições durante a recuperação pós-anestésica e após o retorno à unidade de internação; limitações no pós-operatório hospitalar e após a alta; cuidados após a alta; adaptações e modificações da residência; presença e controle da dor pré e pós-operatória; necessidade de transfusão de sangue; evolução e tratamento das comorbidades; necessidade de ser encaminhado à Unidade de Terapia Intensiva no pós-operatório; e, medicamentos pré-anestésicos e encaminhamento ao Centro Cirúrgico (6,(13)(14)(15)(16)(17)(18)(19)(20) .…”

The use of patient-reported outcomes after routine arthroplasty

“…12,13 However, patients with severely affected states of health generally do not reach the levels of health achieved in those with less severe symptoms before surgery. 12,13 Furthermore, the bounded nature of instruments often limits their ability to discriminate between good and excellent outcomes. Consequently, when evaluating outcomes from the patients' perspective, one has to consider the change as well as the absolute level of pain, function and healthrelated quality of life.…”