Dataset Information

Education attainment is associated with patient-reported outcomes: findings from the Swedish Hip Arthroplasty Register.

ABSTRACT:

Background

Age, sex, and medical comorbidities may be associated with differences in patient-reported outcome scores after THA. Highest level of education may be a surrogate for socioeconomic status, but the degree to which this is associated with patient-reported outcomes after THA is not known.

Questions/purposes

We investigated the national Swedish Hip Arthroplasty Register for the association of education attainment on patient-reported outcomes 1 year after THA; specifically, we evaluated level of education attainment against health-related quality of life (HRQoL), pain reduction, and satisfaction with treatment 1 year after THA.

Methods

All THAs for osteoarthritis performed from 2005 through 2007 with complete patient-reported outcome measures (representing 49% of the THAs performed for this diagnosis) were selected from the Swedish Hip Arthroplasty Register. These cases were merged with national databases containing education attainment, marital status, and comorbidities (n = 11,464; mean age of patients, 64 years). The patient-reported outcome measure protocol included the HRQoL measure EuroQol five-dimension scale (EQ-5D), a VAS for pain, the Charnley classification survey, and a VAS addressing THA satisfaction. Linear regression analyses determined the association of preoperative patient factors with patient-reported outcomes.

Results

High education attainment was associated with higher HRQoL (EQ-5D index ß(high) = 0.03 ± 0.01; EQ VAS ß(high) = 2.6 ± 0.5) after THA, whereas those with low and medium education were at risk for lower HRQoL. High education was associated with less pain after treatment (ß(high) = -3.3 ± 0.05). Individuals with low or medium education were at risk for less satisfaction with THA (p < 0.001).

Conclusions

Our results suggest clinicians should support patients with low and medium education to a greater extent. Identification of patients who will benefit most from THA and educating those at risk for poorer outcomes, like patients with low and medium education, ultimately may improve patient satisfaction, HRQoL, pain, and the cost utility of THA.

Level of evidence

Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

SUBMITTER: Greene ME

PROVIDER: S-EPMC4016468 | biostudies-literature | 2014 Jun

REPOSITORIES: biostudies-literature

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Publications

Education attainment is associated with patient-reported outcomes: findings from the Swedish Hip Arthroplasty Register.

Greene Meridith E ME Rolfson Ola O Nemes Szilard S Gordon Max M Malchau Henrik H Garellick Göran G

Clinical orthopaedics and related research 20140219 6

<h4>Background</h4>Age, sex, and medical comorbidities may be associated with differences in patient-reported outcome scores after THA. Highest level of education may be a surrogate for socioeconomic status, but the degree to which this is associated with patient-reported outcomes after THA is not known.<h4>Questions/purposes</h4>We investigated the national Swedish Hip Arthroplasty Register for the association of education attainment on patient-reported outcomes 1 year after THA; specifically, ...[more]

PMID: 24549772

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Project description:IntroductionThe purpose of this study is to evaluate the role of major psychiatric illness on patient outcomes after total joint arthroplasty.MethodsPatients with a diagnosis of a major psychiatric disorder undergoing total joint arthroplasty were retrospectively matched one-to-one with a cohort without such a diagnosis. Major psychiatric disorder in the registry was identified by diagnosis of anxiety, mood, or a psychotic disorder. Primary outcome of interest included perioperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes included EuroQol-5D, adverse events, length of stay, 30-day readmission, and discharge destination.ResultsTotal number of patients were 1828. The total hip arthroplasty (37.80 ± 17.91, p = 0.023) and the total knee arthroplasty psychiatric group (43.38 ± 18.41, p = 0.050) had significantly lower pre-operative WOMAC scores. At 3 months, the total hip arthroplasty (76.74 ± 16.94, p = 0.036) and total knee arthroplasty psychiatric group (71.09 ± 18.64, p < 0.01) again had significantly lower 3-month post-operative WOMAC score compared to the control groups. However, outcomes at 1 year were difficult to interpret, as patients with major psychiatric conditions had an extremely high loss to follow-up. Compared to the control groups, the total hip arthroplasty and total knee arthroplasty psychiatric group had an increased length of stay by 1.43 days (p < 0.01) and 0.77 days, respectively (p = 0.05). Similarly, the psychiatric groups were discharged directly home less often (total hip arthroplasty 86.9%, p = 0.024 and total knee arthroplasty 87.6%, p = 0.022) than the control groups.ConclusionPatients with the diagnosis of a major psychiatric illness have an increased length of stay and are more likely to require a rehabilitation facility, compared to the control groups. Arguably, of utmost importance, there is a very high rate of loss to follow-up within the psychiatric groups. As such, we recommend these patients should be treated for their diagnosis prior to total joint arthroplasty. Furthermore, importance of clinical follow-up should be emphasized carefully.

Project description:BackgroundComparisons of patient-reported outcomes (PROs) based on surgical approach for total hip arthroplasty (THA) in the United States are limited to series from single surgeons or institutions. Using prospective data from a large, multicenter study, we compare preoperative to postoperative changes in PROs between posterior, transgluteal, and anterior surgical approaches to THA.MethodsPatient-reported function, global health, and pain were systematically collected preoperatively and at 1, 3, and 6 months postoperatively from patients undergoing primary THA at 26 sites participating in the Comparative Effectiveness of Pulmonary Embolism Prevention After Hip and Knee Replacement (ClinicalTrials.gov: NCT02810704). Outcomes consisted of the brief Hip disability and Osteoarthritis Outcome Score, the Patient-Reported Outcomes Measurement Information System Physical Health score, and the Numeric Pain Rating Scale. Operative approaches were grouped by surgical plane relative to the abductor musculature as being either anterior, transgluteal, or posterior.ResultsBetween 12/12/2016 and 08/31/2019, outcomes from 3018 eligible participants were examined. At 1 month, the transgluteal cohort had a 2.2-point lower improvement in Hip disability and Osteoarthritis Outcomes Score (95% confidence interval, 0.40-4.06; P = .017) and a 1.3-point lower improvement in Patient-Reported Outcomes Measurement Information System Physical Health score (95% confidence interval, 0.48-2.04; P = .002) compared to posterior approaches. There was no significant difference in improvement between anterior and posterior approaches. At 3 and 6 months, no clinically significant differences in PRO improvement were observed between groups.ConclusionPROs 6 months following THA dramatically improved regardless of the plane of surgical approach, suggesting that choice of surgical approach can be left to the discretion of surgeons and patients without fear of differential early outcomes.

Project description:Background and purpose - Socioeconomic status is associated with the outcome of major surgery. We investigated the association of socioeconomic status with the risk of early mortality and readmissions after primary total hip arthroplasty (THA). Patients and methods - We obtained information on income, education, immigration, and cohabiting status as well as comorbidities of 166,076 patients who underwent primary THA due to primary osteoarthritis (OA) from the Swedish Hip Arthroplasty Register, the Swedish National Inpatient Register and Statistics Sweden. Multivariable Cox regression models were fitted to estimate the adjusted risk of mortality or readmissions within 90 days after index surgery. Results - Compared with patients on a low income, the adjusted risk of 30-day mortality was considerably lower in patients on a high income (hazard ratio [HR] 0.5, 95% confidence interval [CI] 0.3-0.7) and in those on a medium income (HR 0.7, CI 0.6-0.9). Similar risk reductions were found for the endpoint 90-day mortality. Patients with a high income had a lower adjusted risk of readmission for cardiovascular reasons than those with a low income (HR 0.7, CI 0.6-0.9), as had those with a higher level of education (adjusted HR 0.7, CI 0.6-0.9). Patients with higher socioeconomic status had a lower degree of comorbidities than socioeconomically disadvantaged patients. However, adjusting for socioeconomic confounders in multivariable models only marginally influenced the predictive ability of the models, as expressed by their area under the curve. Interpretation - Income and level of education are strongly associated with early mortality and readmissions after primary THA, and both parameters are closely connected to health status. Since adjustment for socioeconomic confounders only marginally improved the predictive ability of multivariable regression models our findings indicate that comorbidities may under certain circumstances serve as an acceptable proxy measure of socioeconomic background.

Dataset Information

Education attainment is associated with patient-reported outcomes: findings from the Swedish Hip Arthroplasty Register.

Background

Questions/purposes

Methods

Results

Conclusions

Level of evidence

Publications

Education attainment is associated with patient-reported outcomes: findings from the Swedish Hip Arthroplasty Register.

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