The association between pre-operative patient-reported health and post-arthroplasty health survey response rates: a registry-based cohort study. (Preprint)

2021 ◽  
Author(s):  
Ian Harris ◽  
Yi Peng ◽  
Ilana Ackerman ◽  
Steven E Graves
Keyword(s):  
Health Status ◽  
Knee Arthroplasty ◽  
Response Rate ◽  
Response Rates ◽  
Post Surgery ◽  
Utility Index ◽  
Significant Difference ◽  
Patient Reported ◽  
Response Status ◽  
Hip And Knee Arthroplasty

BACKGROUND Patient reported outcome measures (PROMs) are commonly used to report outcomes after hip and knee arthroplasty but response rates are rarely complete. Given that pre-operative health status (as measured by PROMs) is a strong predictor of outcomes (using the same measures) and that these outcomes may influence the response rate, it is possible that post-operative response rates may be influenced by pre-operative health status. OBJECTIVE This study aims to test the association between pre-operative PROMs and post-operative response status following hip and knee arthroplasty. METHODS Data from the PROMs program of a large national registry were used. Pre-operative PROMs were the Oxford Hip Score or Oxford Knee Score, EQ5D Utility Index and the EQ visual analogue scale (VAS) for overall health. Logistic regression, adjusting for age, sex, body mass index (BMI) and American Society of Anesthesiologists (ASA) Physical Status Classification System, was used to test the association between each pre-operative PROM and response status for the 6-months post-surgery survey. RESULTS Data from 9,499 and 16,539 patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) for osteoarthritis, respectively, were included in the analysis. Adjusting for age, sex, BMI and ASA, there was no significant difference in response status at 6 months based on the pre-operative Oxford Hip or Knee Scores (OR 1.00, 95% CI 0.99 to 1.01 for both, p = 0.70 for THA, p = 0.85 for TKA). Healthier patients (based on the EQ VAS scores) pre-operatively were more likely to respond at 6 months, but this difference was negligible (OR 1.00, 95% CI 1.00 to 1.01 for THA and TKA, p = 0.004 for THA, p < 0.001 for TKA). Pre-operative EQ Utility Index was not associated with response rate at 6 months for THA (OR 1.14, 95% CI 0.96 to 1.36, p = 0.13) or TKA patients (OR 1.05, 95% CI 0.91 to 1.22, p = 0.49). CONCLUSIONS Patients who respond to PROMs surveys at 6 months post THA and TKA demonstrated similar pre-operative PROMs scores to those who did not respond. This can allay concerns that differences in pre-operative pain, function and quality of life might introduce bias when assessing surgical outcomes where there is loss to follow-up post-operatively.

scholarly journals Patient-reported outcomes in patients undergoing elective arthroplasty: the PaRIS-IOR study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Golinelli ◽  
S Rosa ◽  
P Rucci ◽  
D Tedesco ◽  
A Grassi ◽  
...  
Keyword(s):  
Health Status ◽  
Knee Arthroplasty ◽  
Short Form ◽  
Perceived Health ◽  
Knee Surgery ◽  
Obese Patients ◽  
Patient Profile ◽  
Outcome Score ◽  
Patient Reported ◽  
Hip And Knee Arthroplasty

Abstract Background The number of hip and knee arthroplasties continues to rise worldwide. The Organization for Economic Cooperation and Development has launched the PaRIS Initiative for the systematic collection of Patient Reported Outcome Measures (PROMs) in patients undergoing elective hip and knee arthroplasty. The Rizzoli Orthopedic Institute (IOR) was selected as a pilot center for the Initiative (PaRIS-IOR study), because it hosts the Registry of Orthopedic Prosthetic Implants (RIPO). The objective of PaRIS-IOR study is to investigate the characteristics and temporal trend of PROMs in relation to the type of surgical intervention and patient profile. Here we report the preliminary results of the first study year. Methods The PaRIS-IOR is a prospective, single site, cohort study started on January 1st 2019 that consists of the administration of Euro Quality 5 Dimensions (EQ-5D), Hip disability and Osteoarthritis Outcome Score and Knee injury and Osteoarthritis Outcome Score Physical function Short-form (HOOS-PS, KOOS-PS) questionnaires to patients on the list for elective arthroplasty. Questionnaires data are linked with those routinely collected by the RIPO and regional administrative data, in order to track patients' medical history. Results The study population consists of 1,413 patients. Patients undergoing knee arthroplasty (n = 393) were older (68.4 vs 60.2 years; p &lt; 0.001), and had a higher prevalence of obesity (41.6 vs 22.6%; p &lt; 0.001) than patients undergoing hip arthroplasty (n = 1020). Female and obese patients reported a worse perceived health status both in the EQ-5D (p &lt; 0.001) and in the HOOS-PS and KOOS-PS (p &lt; 0.001). Among patients who underwent knee surgery, the younger ones reported a poorer perceived health in the general and the specific questionnaires. Conclusions The PaRIS-IOR study has potential important implications in targeting the factors affecting patient-reported functional outcomes and quality of life after joint arthroplasty. Key messages The PaRIS-IOR study underscores the poorer perception of health status in female and obese patients undergoing arthroplasty and in younger patients undergoing knee surgery. The routine adoption of PROMs may support surgeons in the management of patients undergoing hip and knee arthroplasty and policy-makers in improving healthcare quality in orthopedics.

scholarly journals Validity of patient-reported complications after total hip and knee arthroplasty

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901880249 ◽  
Author(s):  
Kinh Luan Thanh Dang ◽  
Helen Badge ◽  
Ian A Harris
Keyword(s):  
Knee Arthroplasty ◽  
High Volume ◽  
Total Hip ◽  
Joint Replacement Surgery ◽  
Patient Reports ◽  
Replacement Surgery ◽  
Telephone Interviews ◽  
Patient Reported ◽  
Hip And Knee Arthroplasty ◽  
High Level

Background: Evaluating the effectiveness of total hip arthroplasty (THA) and total knee arthroplasty (TKA) often relies on accurate patient reporting of postoperative complications. Despite this, there is little research regarding the accuracy of patient reports. We aimed to determine the accuracy of patient-reported significant complications after THA and TKA. Methods: Patients were recruited prior to undergoing primary hip or knee arthroplasty at 19 high-volume hospitals. After surgery, follow-up of patients via telephone interviews at 35, 90 and 365 days recorded surgical outcomes including readmission, reoperation and venous thromboembolism (VTE). Patient-reported complications were verified via medical record audits and liaison with surgeons, general practitioners or other health professionals. Surgical and demographic information and patient-reported and verified complications were entered into a database. Patient-reported and verified complications were compared for readmission, reoperation and VTE. Results: The sample included 150 of 1811 patients who reported a total of 242 significant complications. Of the 242 patient-reported complications, 224 (92.6%) were correct (true positive). The type of complication had variable levels of accuracy in patient reports. Readmission to hospital was accurately reported by 90.2% (129/143) of patients. Reoperation (including any manipulations under anaesthesia, joint washouts, reductions of dislocated joints and revisions) was accurately reported by 98.7% (75/76) of patients. VTE was accurately reported by 86.7% (20/23) of patients. Conclusion: A high level of accuracy in patient-reported experience of complications was demonstrated following THA and TKA. Patient-reported complications may be reliably used for post-operative surveillance of joint replacement surgery.

The effectiveness of robotic hip and knee arthroplasty on patient-reported outcomes: A systematic review and meta-analysis

2018 ◽  
Vol 43 (6) ◽  
pp. 1283-1295 ◽  
Author(s):  
Sascha Karunaratne ◽  
Michael Duan ◽  
Evangelos Pappas ◽  
Brett Fritsch ◽  
Richard Boyle ◽  
...  
Keyword(s):  
Systematic Review ◽  
Knee Arthroplasty ◽  
Patient Reported Outcomes ◽  
Meta Analysis ◽  
Patient Reported ◽  
Hip And Knee Arthroplasty

Evaluation of the Efficacy of Liposomal Bupivacaine in Total Joint Arthroplasty

2019 ◽  
pp. 089719001987257
Author(s):  
Francis J. Zamora ◽  
Rani P. Madduri ◽  
Ashmi A. Philips ◽  
Nancy Miller ◽  
Mini Varghese
Keyword(s):  
Knee Arthroplasty ◽  
Pain Control ◽  
Standard Of Care ◽  
P Value ◽  
Opioid Use ◽  
Post Surgery ◽  
Likert Score ◽  
Average Pain ◽  
Hip And Knee Arthroplasty ◽  
The Difference

Background: Appropriate pain control is one of the cornerstones necessary to promote positive clinical outcomes. A new bupivacaine liposomal formulation was designed to extend its analgesic effect for up to 72-hours post-surgery, reportedly leading to significant opioid-sparing. Method: Retrospective and prospective chart review conducted in a 178-bed academic institution between January 2013 to December 2013 and August 2014 to November 2014, in 115 patients that receive hip and knee arthroplasty. The primary outcome was the measurement of average daily pain score on post-operative days 1 and 2. Secondary outcomes included length of stay, overall opioid use post-surgery and pain control satisfaction using Press-Ganey® scores. Results: The average pain scores in the HCl group were 4.64 and 4.38 (Likert score: 0-10) for POD 1 and POD 2, compared to 4.72 POD 1 and 4.2 POD 2 in the liposome group (POD 1: p = 0.413; POD 2: p = 0.303). The difference in LOS for knee arthroplasty was statistically significant [HCl group: 1.94 days (± 0.66) versus liposome group: 2.27 days (±0.77) p-value = 0.038)] favoring the standard of care. For hip arthroplasty or bilateral knee arthroplasty the differences in LOS were not statistically significant ( p = 0.052 and p = 0.484 respectively). 93% of the patients in the HCl group, pain was well controlled, versus 88.5% in the liposome group with similar oxycodone IR use among groups. Conclusion: Liposome bupivacaine did not offer a notable benefit compared to the HCl formulation in our study.

scholarly journals Meta-Analysis: A Comparison of Aspirin and Rivaroxaban for Prophylaxis of Venous Thromboembolism After Hip or Knee Arthroplasty.

2021 ◽  
Author(s):  
Md Ariful Haque ◽  
Xiong Ying ◽  
Sayed Abdulla Jami ◽  
Ren YunFeng ◽  
Siam Al Mobarak ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Knee Arthroplasty ◽  
Health Care Professionals ◽  
Meta Analysis ◽  
Cost Effective ◽  
Hip Fracture Surgery ◽  
Effective Interventions ◽  
Cochrane Database ◽  
Significant Difference ◽  
Hip And Knee Arthroplasty

Abstract Purpose: Knee arthroplasty and hip arthroplasty (THA) patients are susceptible to post-operative venous thromboembolism(VTE). Doctors are increasingly recommending the application of different thromboprophylaxis agents such as rivaroxaban. The agents are primarily effective in preventing thromboembolism after hip and knee arthroplasty. Similarly, recent research suggests aspirin as one of the cost-effective interventions for preventing thromboembolism. Accordingly, this meta-analysis aims to compare the effectiveness of Aspirin against Rivaroxaban for the prevention or treatment of thromboembolism following knee arthroplasty and knee arthroplasty.Methods: The researcher relied on electronic searches of about five databases. The database searches identified relevant studies used to extract meta-analyzed data and information. The databases included PubMed, Cinahl, Medicine, Cochrane Database of Systematic Reviews(CDSR), Pharma GKB, SAGE, from inception to December 2020.Results: Different studies from the five databases we are included in this study. The studies include 2257 in the aspirin group and 2337 in the rivaroxaban group. The result revealed no significant difference between Aspirin and Rivaroxaban for the treatment of venous thromboembolism.Conclusion: The meta-analysis result affirmed no statistically significant difference between Aspirin and Rivaroxaban in preventing venous thromboembolism, a joint arthroplasty, or hip fracture surgery. However, some health care professionals find aspirin a more effective, safe, convenient, and affordable alternative for preventing venous thromboembolism. Thus the meta-analysis recommends extensive randomized studies to confirm the stipulated outcomes.

scholarly journals The mildly decreased preoperative bilirubin level is a risk factor for periprosthetic joint infection after total hip and knee arthroplasty

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Jun Fu ◽  
Xiyue Chen ◽  
Ming Ni ◽  
Xiang Li ◽  
Libo Hao ◽  
...  
Keyword(s):  
Risk Factor ◽  
Bilirubin Level ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Primary Arthroplasty ◽  
Significant Difference ◽  
Serologic Markers ◽  
Hip And Knee Arthroplasty ◽  
Laboratory Biomarkers

Abstract Background Many serologic markers are routinely tested prior to joint arthroplasty, but only few are commonly used to guide surgeons in determining patients most at risk of periprosthetic joint infection (PJI). The objective of this study was to investigate the association between preoperative bilirubin level and PJI after primary hip and knee arthroplasty. Methods A retrospective analysis was performed on patients undergoing revision hip and knee arthroplasty at our hospital from January 2016 to December 2019. Laboratory biomarkers were collected before the primary arthroplasty, as well as general patient information. The association between the above serologic markers and postoperative PJI was analyzed. Results A total of 72 patients (30 hips/42 knees) were analyzed, including 39 patients with PJI and 33 patients without PJI. Except for total bilirubin (TB) and direct bilirubin (DB), there was no significant difference between the remaining laboratory biomarkers. The preoperative TB and DB in the PJI group were 10.84 ± 0.61 μmol/L and 3.07 ± 0.19 μmol/L, respectively, which were lower than those in the non-PJI group (14.68 ± 0.75 μmol/L and 4.70 ± 0.39 μmol/L, P < 0.001). The area under the curve (AUC) of preoperative TB to predict PJI was 0.755 (P < 0.001, cutoff = 11.55 μmol/L, sensitivity = 66.67%, specificity = 75.76%). Meanwhile, the AUC of preoperative DB was 0.760 (P < 0.001, cutoff = 4.00 μmol/L, sensitivity = 84.62%, specificity = 54.45%). Conclusions The serum levels of TB and DB before the primary arthroplasty were lower in PJI patients than in non-PJI patients, and the preoperative values lower than 11.55 μmol/L and 4.00 μmol/L could be considered as a risk factor for postoperative PJI.

scholarly journals Effect of Recruitment Methods on Response Rate in a Web-Based Study for Primary Care Physicians: Factorial Randomized Controlled Trial (Preprint)

2017 ◽  
Author(s):  
Ryuhei So ◽  
Kiyomi Shinohara ◽  
Takuya Aoki ◽  
Yasushi Tsujimoto ◽  
Aya M Suganuma ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Response Rate ◽  
Controlled Trial ◽  
Response Rates ◽  
Risk Difference ◽  
Web Based ◽  
Subject Line ◽  
Significant Difference ◽  
The Subject

BACKGROUND Low participation rates are one of the most serious disadvantages of Web-based studies. It is necessary to develop effective strategies to improve participation rates to obtain sufficient data. OBJECTIVE The objective of this trial was to investigate the effect of emphasizing the incentive in the subject line of the invitation email and the day of the week of sending the invitation email on the participation rate in a Web-based trial. METHODS We conducted a 2×2 factorial design randomized controlled trial. We contacted 2000 primary care physicians from members of the Japan Primary Care Association in January 2017 and randomly allocated them to 1 of 4 combinations of 2 subject lines (presence or absence of an emphasis on a lottery for an Amazon gift card worth 3000 yen or approximately US $30) and 2 delivery days (sending the invitation email on Tuesday or Friday). The primary outcome was the response rate defined as the number of participants answering the first page of the questionnaire divided by the number of invitation emails delivered. All outcomes were collected between January 17, 2017, and February 8, 2017. RESULTS We analyzed data from 1943 out of 2000 participants after excluding those whose email addresses were invalid. The overall response rate was 6.3% (123/1943). There was no significant difference in the response rates between the 2 groups regarding incentive in the subject line: the risk ratio was 1.12 (95% CI 0.80 to 1.58) and the risk difference was 0.7% (95% CI –1.5% to 2.9%). Similarly, there was no significant difference in the response rates between the 2 groups regarding sending the email on Tuesday or Friday: the risk ratio was 0.98 (95% CI 0.70 to 1.38) and the risk difference was –0.1% (95% CI –2.3% to 2.1%). CONCLUSIONS Neither emphasizing the incentive in the subject line of the invitation email nor varying the day of the week the invitation email was sent led to a meaningful increase in response rates in a Web-based trial with primary care physicians. CLINICALTRIAL University Hospital Medical Information Network Clinical Trials Registry UMIN000025317; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000029121 (Archived by WebCite at http://www.webcitation. org/6wOo1jl9t)

scholarly journals The use of patient-reported outcome measures in hip and knee arthroplasty in Alberta

2021 ◽  
Vol 5 (S2) ◽  
Author(s):  
Deborah A. Marshall ◽  
Xuejing Jin ◽  
Lindsay B. Pittman ◽  
Christopher J. Smith
Keyword(s):  
Decision Making ◽  
Quality Improvement ◽  
Continuous Quality Improvement ◽  
Performance Indicators ◽  
Care Pathway ◽  
Continuous Quality ◽  
Post Surgery ◽  
Measurement Framework ◽  
Patient Reported ◽  
Hip And Knee Arthroplasty

AbstractPROMs are part of routine measurement for hip and knee replacement in Alberta, Canada. We provide an overview of how PROMs are implemented in routine care, and how we use PROMs data for decision-making at different levels within the health system. The Alberta Bone and Joint Health Institute (ABJHI) ran a randomized controlled trial to determine the effectiveness and cost-effectiveness of an evidence-based care pathway for hip and knee arthroplasty in 2004. The study included several PROMs questionnaires: Western Ontario and McMaster Universities Osteoarthritis Index, Health Utility Index, Short Form 36 and the EQ-5D-3L. Subsequently, the focus shifted to spread and scale of the care pathway provincially. WOMAC and EQ-5D-3L and a patient experience survey were selected for provincial adoption – captured before surgery, three-months post-surgery, and 12-months post-surgery. These PROMs data were integrated into research and routine clinical practice at the micro, meso and macro levels. At the micro level, PROMs data are used at the individual patient and provider level for patients to provide input on their care and as a tool to communicate with their healthcare providers. We examined the relationship of appropriateness and patient reported outcomes in a prospective cohort study. We evaluated whether routinely collected PROMs could be integrated into a patient decision aid to better inform shared decision making. At the meso level, continuous quality improvement reports are provided routinely to individual health care providers, hospitals and clinics on their performance against the measurement framework and standard key performance indicators. At the macro level, PROMs data are used to evaluate system performance by comparing outcomes across different jurisdictions or over time and support health policy decision making. Combined with administrative databases, we have used simulation models to reflect transition through the continuum of care from disease onset through end-stage care regarding the burden of disease, healthcare resource requirements and associated healthcare costs. The addition of PROMs data in clinical repositories and analyses enables the system to identify and address issues of continuous quality improvement against a measurement framework of performance indicators and to explicitly recognize the trade-offs that are inherent in any resource-constrained system.

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