背景:患者报告的过敏(PRAs)已被确定为膝关节和髋关节置换术患者预后较差和满意度较低的危险因素。在肩关节置换术患者中尚未阐明类似的关联;但是,以前的研究是稀疏的。这项研究的目的是评估肩关节置换术后患者报告的药物过敏的结果。据推测,较高数量的过敏与肩关节置换术后患者报告的预后(PRO)较差有关。
方法:回顾了在2005年10月至2018年3月期间由一名外科医生进行初次肩关节置换术的手术时年龄在18-89岁的连续患者,并进行了至少1年的随访。PRO分数,包括美国肩肘外科医生的分数,单项评估数值评估评分,QuickDASH(简版的手臂残疾,肩和手问卷)评分,和12项简短形式健康调查身体成分汇总和心理成分汇总得分,以及患者满意度,在术前和术后收集。报告了早期临床失败。根据PRA的数量(0、1或≥2)将受试者分为3级因子,使用Kruskal-Wallis分析对平均术后PRO评分进行了双变量比较.此外,进行多元回归以评估PRAs对PRO的影响,同时控制年龄,性别,关节成形术类型,基线PRO分数,和Charlson合并症指数。
结果:总体而言,最终研究人群包括411名肩膀(367名患者,其中44人受到双边治疗)。人口主要是男性患者(n=265,64.5%),手术时的中位年龄为66.5岁(第一四分位数-第三四分位数,61.3-71.4年)。在患者中,253例(61.6%)接受了全肩关节置换术(TSA),而158例(38.4%)接受了反向TSA。5例患者(2例TSA和3例TSA逆转患者)经历了早期临床失败并需要进行翻修手术。406例患者中的345例(85.0%)获得了至少1年的PRO,平均随访期为1.9±1.2年。几乎所有的术后PRA都反映了更多的术前PRA预后较差的趋势;然而,QuickDASH评分是唯一显示过敏组之间存在显著差异的评分(P=.004).使用Nemenyi事后测试的成对比较表明,与过敏0组相比,过敏≥2组的QuickDASH评分明显更高(结果更差)。PRA被发现是术后QuickDASH评分较高的统计学显着预测因子(P=.043),并且比Charlson合并症指数和性别更具影响力。此外,PRA是患者满意度的唯一有统计学意义的预测因子(P=0.016)。
结论:术前PRA数量的增加与肩关节置换术后PROs和患者满意度的降低相关。PRA的数量是患者满意度最具影响力的预测因子。
BACKGROUND: Patient-reported allergies (PRAs) have been identified as a risk factor for worse outcomes and less satisfaction in patients undergoing knee and hip arthroplasty. Similar associations have not been elucidated in shoulder arthroplasty patients; however, previous research is sparse. The purpose of this study was to assess the outcomes following shoulder arthroplasty surgery with respect to patient-reported drug allergies. It was hypothesized that a higher number of allergies would be associated with worse patient-reported outcomes (PROs) following shoulder arthroplasty surgery.
METHODS: Consecutive patients aged 18-89 years at the time of surgery who underwent primary shoulder arthroplasty between October 2005 and March 2018 performed by a single surgeon and had a minimum follow-up period of 1 year were reviewed. PRO scores, including the American Shoulder and Elbow Surgeons score, Single Assessment Numerical Evaluation score, QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score, and 12-Item Short Form Health Survey Physical Component Summary and Mental Component Summary scores, as well as patient satisfaction, were collected preoperatively and postoperatively. Early clinical failures were reported. Subjects were categorized into a 3-level factor based on the number of PRAs (0, 1, or ≥2), and bivariate comparisons of mean postoperative PRO scores were performed using Kruskal-Wallis analyses. Additionally, multivariate regression was performed to assess the effect of PRAs on PROs while controlling for age, sex, arthroplasty type, baseline PRO scores, and Charlson Comorbidity Index.
RESULTS: Overall, 411 shoulders were included in the final study population (367 patients, 44 of whom were treated bilaterally). The population was predominately male patients (n = 265, 64.5%), and the median age at the time of surgery was 66.5 years (first quartile-third quartile, 61.3-71.4 years). Of the patients, 253 (61.6%) underwent total shoulder arthroplasty (TSA) whereas 158 (38.4%) underwent reverse TSA. Five patients (2 TSA and 3 reverse TSA patients) experienced early clinical failure and required revision surgery. Minimum 1-year PROs were obtained for 345 of 406 patients (85.0%) with a mean follow-up period of 1.9 ± 1.2 years. Nearly all postoperative PROs reflected a trend of worse outcomes with more preoperative PRAs; however, the QuickDASH score was the only score showing a significant difference between allergy groups (P = .004). Pair-wise comparison using Nemenyi post hoc testing showed that the QuickDASH score was significantly higher (worse outcomes) for the group with ≥2 allergies compared with the group with 0 allergies. PRA was found to be a statistically significant predictor of higher postoperative QuickDASH scores (P = .043) and was more influential than the Charlson Comorbidity Index and sex. Additionally, PRA was the only statistically significant predictor of patient satisfaction (P = .016).
CONCLUSIONS: An increasing number of preoperative PRAs is associated with worse PROs and patient satisfaction following shoulder arthroplasty. The number of PRAs was the most influential predictor of patient satisfaction.