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手术前患者报告的结果可以预测膝关节整形术后的临床结果吗?

Jonathan L Katzman¹, Casey Cardillo¹, Benjamin C Schaffler¹

¹Department of Orthopedic Surgery, NYU Langone Health, New York, New York.

The Journal of arthroplasty

|September 3, 2025

概括

与已知工具相比,手术前患者报告的结果测量 (PROMs) 预测膝关节整形术结果的能力有限. 需要更强大的PROM来更好地规划基于价值的护理.

科学领域:

骨科手术
健康成果研究
基于价值的医疗保健

背景情况:

通过CMS强制收集患者报告的全膝关节整形术 (TKA) 的结果测量 (PROM).
关于手术前PROM对TKA临床结果的预测效益的不确定性.
将PROM与已建立的指数比较,例如查尔森并发症指数 (CCI) 和风险评估和预测工具 (RAPT).

研究的目的:

将手术前PROM的预测能力与已建立的TKA结果进行比较.
评估PROM与特定临床结果的关联,如当天出院和再入院.
为建立基于价值的护理模式提供更好的PROM.

主要方法:

对接受初级单侧TKA的2923名患者进行了回顾性审查.
关节置换 (KOOS JR) 和PROMIS®领域的手术前膝关节损伤和骨关节炎结局得分的收集.
使用ROC曲线 (AUC) 和多变量后勤回归来评估预测效用,包括释放,停留时间,再接收和修订.

主要成果:

RAPT评分是同日出院,长时间住院和非家庭出院的最强预测因素.
身体和精神健康领域对出院结果的预测价值很低.
CCI是90天再接收的最强预测因素;没有PROM预测再接收或修订.
更高的PROMIS心理健康与同日出院的增加和长时间停留的减少有关.

结论:

与RAPT相比,手术前的PROM对TKA结果的预测能力有限.
与非家庭出院的减少有关.
需要改进,与结果一致的PROM来加强基于价值的护理中的手术规划.

关键词:

整体膝关节整形排放情况停留时间患者报告的结果重新接纳进行修订风险分层

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