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社会脆弱性对急诊室利用情况产生不利影响,但对全关节关节整形术后患者报告的结果没有不利影响
Samantha N Baxter1, Andrea H Johnson1, Jane C Brennan1
1Anne Arundel Medical Center Inc, 2000 Medical Parkway, Annapolis, MD, 21401, USA.
Archives of orthopaedic and trauma surgery
|January 11, 2024
概括
社会脆弱性增加了关节和膝盖置换后90天的急诊室 (ED) 返回. 然而,社会脆弱的患者在手术后一年仍能获得良好的功能结果.
科学领域:
- 整形外科手术结果的结果
- 公共卫生和健康的社会决定因素.
- 患者报告的结果衡量结果.
背景情况:
- 社会剥夺与全部 (THA) 和膝盖 (TKA) 关节整形术的较差结果有关.
- 在这些程序后,社会脆弱性对患者报告的结果 (PROM) 的影响尚未完全理解.
- 本研究研究了社会脆弱性和THA/TKA后的功能结果之间的关系.
研究的目的:
- 评估社会脆弱性与THA和TKA患者的PROMIS-PF措施之间的关联.
- 为了比较有增加资源利用率或并发症的患者与没有的患者的社会脆弱性水平.
- 确定特定的社会脆弱性因素,影响关节塑形术后的结果.
主要方法:
- 从2020年3月至2022年2月接受THA/TKA治疗的537名患者的回顾性评估.
- 利用疾病控制中心的社会脆弱性指数 (SVI) 来量化社会经济劣势.
- 进行单变量和多变量分析以评估结果,统计显著性设置为p < 0.05.
主要成果:
- 较高的整体社会脆弱性与TKA后90天急诊室 (ED) 返回率的增加有关 (0.40对0.28,p=0.03).
- 增加的整体SVI和家庭特征SVI独立预测TKA后90天的ED回报 (OR=9.18,p=0.027;OR=9.57,p=0.015).
- 在家庭类型和运输中易受伤害的THA患者更有可能需要90天的ED返回 (0.51比0.37,p=0.04).
结论:
- 尽管患有90天ED复发的风险增加,但在THA/TKA治疗后,社会脆弱性较高的患者在1年内获得了良好的功能结果.
- 社会剥夺并不排除长期积极的功能恢复.
- 未来的举措应侧重于提供安全的ED护理替代方案,以减轻社会脆弱性对联合替代结果的影响.
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