| アブストラクト | OBJECTIVE: Identify risk factors for poor pain outcomes six months after primary knee replacement surgery. METHODS: Observational cohort study on patients receiving primary knee replacement from the UK Clinical Practice Research Datalink, Hospital Episode Statistics and Patient Reported Outcomes. A wide range of variables routinely collected in primary and secondary care were identified as potential predictors of worsening or only minor improvement in pain, based on the Oxford Knee Score pain subscale. Results are presented as relative risk ratios and adjusted risk differences (ARD) by fitting a generalized linear model with a binomial error structure and log link function. RESULTS: Information was available for 4,750 patients from 2009 to 2016, with a mean age of 69, of whom 56.1% were female. 10.4% of patients had poor pain outcomes. The strongest effects were seen for pre-operative factors: mild knee pain symptoms at the time of surgery (ARD 18.2% (95% Confidence Interval 13.6, 22.8), smoking 12.0% (95% CI:7.3, 16.6), living in the most deprived areas 5.6% (95% CI:2.3, 9.0) and obesity class II 6.3% (95% CI:3.0, 9.7). Important risk factors with more moderate effects included a history of previous knee arthroscopy surgery 4.6% (95% CI:2.5, 6.6), and use of opioids 3.4% (95% CI:1.4, 5.3) within three months after surgery. Those patients with worsening pain state change had more complications by 3 months (11.8% among those in a worse pain state vs. 2.7% with the same pain state). CONCLUSIONS: We quantified the relative importance of individual risk factors including mild pre-operative pain, smoking, deprivation, obesity and opioid use in terms of the absolute proportions of patients achieving poor pain outcomes. These findings will support development of interventions to reduce the numbers of patients who have poor pain outcomes. |
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| ジャーナル名 | PloS one |
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| Pubmed追加日 | 2022/1/1 |
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| 投稿者 | Mohammad, Hasan Raza; Gooberman-Hill, Rachael; Delmestri, Antonella; Broomfield, John; Patel, Rita; Huber, Joerg; Garriga, Cesar; Eccleston, Christopher; Pinedo-Villanueva, Rafael; Malak, Tamer T; Arden, Nigel; Price, Andrew; Wylde, Vikki; Peters, Tim J; Blom, Ashley W; Judge, Andrew |
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| 組織名 | Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences,;Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom.;Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical;School, University of Bristol, Learning and Research Building, Bristol, United;Kingdom.;National Institute for Health Research Bristol Biomedical Research Centre,;University Hospitals Bristol and Weston NHS Foundation Trust and University of;Bristol, Bristol, United Kingdom.;Nuffield Department of Orthopaedics, Centre for Statistics in Medicine,;Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre,;University of Oxford, Oxford, United Kingdom.;Department of Orthopedics, Stadtspital Triemli, Zurich, Switzerland.;Nuffield Department of Primary Care Health Sciences, University of Oxford,;Oxford, United Kingdom.;Department for Health, Centre for Pain Research, University of Bath, Bath, United;Population Health Sciences, Bristol Medical School, University of Bristol,;Learning and Research Building, Bristol, United Kingdom. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/34972159/ |
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