全髋关节置换术后患者报告结局现状及影响因素分析

Analysis on the patient reported outcomes of total hip arthroplasty and their influencing factors

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，SPSS 19.0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。

Abstract:

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 May 2016 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 post－operative 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 ef－fective intervention for these patients while in hospital and the continued care after discharge should be strengthened.