Poster Presentations

Start Date

20-5-2014 12:30 PM

Description

Introduction: Because total knee replacement (TKR) surgery is performed to relieve pain and improve physical function in patients with advanced arthritis, patient-reported outcomes (PROs) are important to assess TKR effectiveness. The UK and others require PROs. Understanding pre-existing clinical factors that influence PROs after surgery is needed before comparing PROs across providers. We evaluated the roles of medical and musculoskeletal comorbidities in explaining variation in 6 month post-TKR pain relief and functional gain in a national cohort of TKR patients.

Materials & methods: FORCE-TJR, funded by the Agency for Healthcare Research and Quality (AHRQ), is a national consortium in which 100% patients, surgeons and hospitals submit data: patients demographics (age, gender, BMI, race), complete medical and musculoskeletal comorbidities, PROs including SF-36 Physical Component Score (PCS), Knee injury and Osteoarthritis Outcome Score (KOOS), clinically refined adverse events and implant data. Predictors of change in pre-to-6 month post-TKR pain and function were examined using linear mixed models adjusting for clustering within site.

Results: TKR patients had a mean age of 67 years, mean BMI of 31.2, were 63% female and 4.5% black, 9% with Charlson Comorbidity Index (CCI) of 2-5, 15% with CCI of 6, 7% moderate/severe pain in 2-3 knee/hip joints, 27% moderate/severe lumbar pain. After adjusting for socio-demographic factors, significant predictors of poorer 6 month post-TKR pain included poorer emotional health, higher CCI, 1-2 nonsurgical hip/knee joints with moderate/severe pain, any lumbar pain at time of TKR. These same factors also predicted poorer 6 month function.

Conclusion: Before adopting PROs as a standard measure of TKR outcome, a complete understanding of pre-existing clinical factors associated with poorer pain relief and functional gain is needed. Greater musculoskeletal, and medical, comorbid conditions were associated with post-operative PROs and should be included in risk-adjustment models before cross-hospital comparisons can be made.

Comments

Abstract of poster presented at the 2014 UMass Center for Clinical and Translational Science Research Retreat, held on May 20, 2014 at the University of Massachusetts Medical School, Worcester, Mass.

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May 20th, 12:30 PM

Predictors of Patient-reported Outcomes after TKR not Included in Risk Models Based on Administrative Data

Introduction: Because total knee replacement (TKR) surgery is performed to relieve pain and improve physical function in patients with advanced arthritis, patient-reported outcomes (PROs) are important to assess TKR effectiveness. The UK and others require PROs. Understanding pre-existing clinical factors that influence PROs after surgery is needed before comparing PROs across providers. We evaluated the roles of medical and musculoskeletal comorbidities in explaining variation in 6 month post-TKR pain relief and functional gain in a national cohort of TKR patients.

Materials & methods: FORCE-TJR, funded by the Agency for Healthcare Research and Quality (AHRQ), is a national consortium in which 100% patients, surgeons and hospitals submit data: patients demographics (age, gender, BMI, race), complete medical and musculoskeletal comorbidities, PROs including SF-36 Physical Component Score (PCS), Knee injury and Osteoarthritis Outcome Score (KOOS), clinically refined adverse events and implant data. Predictors of change in pre-to-6 month post-TKR pain and function were examined using linear mixed models adjusting for clustering within site.

Results: TKR patients had a mean age of 67 years, mean BMI of 31.2, were 63% female and 4.5% black, 9% with Charlson Comorbidity Index (CCI) of 2-5, 15% with CCI of 6, 7% moderate/severe pain in 2-3 knee/hip joints, 27% moderate/severe lumbar pain. After adjusting for socio-demographic factors, significant predictors of poorer 6 month post-TKR pain included poorer emotional health, higher CCI, 1-2 nonsurgical hip/knee joints with moderate/severe pain, any lumbar pain at time of TKR. These same factors also predicted poorer 6 month function.

Conclusion: Before adopting PROs as a standard measure of TKR outcome, a complete understanding of pre-existing clinical factors associated with poorer pain relief and functional gain is needed. Greater musculoskeletal, and medical, comorbid conditions were associated with post-operative PROs and should be included in risk-adjustment models before cross-hospital comparisons can be made.

 

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