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

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.University and Chongqing Hospital of Traditional Chinese Medicine from 2015 to 2017 were enrolled and randomly divided into early goal-directed therapy（EGDT） group with 28 patients and EVLW+P（cv-a）CO2/C（a-cv）O2 group with 22 patients（P/C group）. Mean arterial pressure（MAP），heart rate（HR），and central venous pressure（CVP） were con－tinuously monitored for all patients，and arterial blood samples and central venous blood samples were collected for blood gas analysis to measure PaCO2，PcvCO2，PcvO2，ScvO2，Hbcv，PaO2，SaO2，Hba，and blood lactate at the time of ICU admission and at 6 hours after resuscitation. P（cv-a）CO2/C（a-cv）O2 was calculated；CaO2=1.34×Hba×SaO2+0.003×PaO2，CcvO2=1.34×Hbcv× ScvO2+0.003×PcvO2，and C（a-cv）O2=CaO2-CcvO2. For patients in the P/C group，extravascular lung water（EVLW） was measured by pulse-induced contour cardiac output（PiCCO），once every 3 hours，and the mean value of three consecutive measurements was recorded. Lactate clearance rate was calculated according to the following equation：lactate clearance rate=（blood lactate value at the time of ICU admission-blood lactate value at 6 hours after resuscitation）/blood lactate value at the time of ICU admission×100%. The dose of the vasoactive agent norepinephrine within 6 hours after resuscitation was compared between the two groups. The 28-day mortality rate was calculated. Related indices after fluid resuscitation were compared between the two groups. Results：There were no significant differences between the two groups in MAP，ScvO2，and the proportion of patients achieving EGDT target at 6 hours after fluid resus－citation（P>0.05）. Compared with the EGDT group，the P/C group had significantly higher lactate clearance rate at 6 hours after fluid resuscitation and urine volume per hour（P<0.05），as well as significantly lower resuscitation fluid volume，CVP，P（cv-a）CO2/C（a-cv）O2，and dose of vasoactive agent（P<0.05）. There was no significant difference in 28-day mortality rate between the two groups（P>0.05）. Conclusion：EVLW combined with P（cv-a）CO2/C（a-cv）O2 can be used to guide EGDT for septic shock. It can accurately evaluate tissue perfusion and volume load in patients with septic shock as early as possible and guide the rational use of liquid therapy and vasoactive drugs in clinical practice.