THE IMPORTANCE OF COEXISTENT DISEASE IN THE OCCURRENCE OF POSTOPERATIVE COMPLICATIONS AND ONE-YEAR RECOVERY IN PATIENTS UNDERGOING TOTAL HIP-REPLACEMENT - COMORBIDITY AND OUTCOMES AFTER HIP-REPLACEMENT
THE IMPORTANCE OF COEXISTENT DISEASE IN THE OCCURRENCE OF POSTOPERATIVE COMPLICATIONS AND ONE-YEAR RECOVERY IN PATIENTS UNDERGOING TOTAL HIP-REPLACEMENT - COMORBIDITY AND OUTCOMES AFTER HIP-REPLACEMENT
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DOI：
10.1097/00005650-199302000-00005
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发表时间：
1993-02-01
期刊：
影响因子：
3
通讯作者：
CLEARY, PD
中科院分区：
文献类型：
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作者：
GREENFIELD, S;APOLONE, G;CLEARY, PD
在以死亡率为终点的护理质量和有效性研究中，共存或共病被认为是预后因素。在术后住院并发症或术后长期恢复的研究中，还没有记录到需要测量和调整合并症。在这项研究中，我们确定了合并症对全髋关节置换术住院患者术后并发症和1年健康相关生活质量的影响。研究人群包括在加州和马萨诸塞州的四家教学医院住院接受全髋关节置换术的356例患者。回顾患者的医疗记录，以收集有关疾病严重程度、共存疾病和术后并发症的信息。使用四级共存疾病指数（ICED）从入院时的病历信息中测量基线术前共存疾病的种类和数量。出院后约12个月，对283名（80%）患者进行了问卷调查。合并症的存在和数量是术后并发症的重要预测因素。ICED最低和最高节段之间的并发症发生率范围为3%至41%。在四家研究医院接受治疗的患者术后1年的功能结局不同。功能结局与ICED评分密切相关：4级ICED患者的工具性日常生活活动评分比1级患者低26.8分。在控制性别、年龄、教育程度和婚姻状况后，ICED仍然是1年时功能状态的重要预测因素。此外，当ICED被纳入模型中以调整手术时的患者特征时，医院间功能结局的差异消失了。共存疾病的测量是解释全髋关节置换患者恢复医院之间差异的关键。
Co-existent or comorbid diseases are appreciated as prognostic factors in studies of quality and effectiveness of care when mortality is the end point. The need to measure and adjust for comorbidity in studies of postoperative hospital complications or long-term recovery from surgery has not been documented. In this study, we determined the impact of co-existent disease on post-operative complications and 1-year health-related quality of life in patients hospitalized for a total hip replacement. The study population consisted of a cohort of 356 patients who were hospitalized in four teaching hospitals in California and Massachusetts for a total hip replacement. Patients' medical records were reviewed to collect information regarding severity of illness, co-existent disease, and postoperative complications. The kind and amount of baseline preoperative co-existent disease was measured from medical record information at admission using a four level Index of co-existent Disease (ICED). Approximately 12 months after hospital discharge, 283 (80%) of the patients were surveyed by questionnaire. The presence and amount of co-existent disease were significant predictors of postoperative complications. The complication rates ranged from 3% to 41% between the lowest and highest levels of the ICED. Patients treated at the four study hospitals differed in functional outcomes 1 year after surgery. Functional outcomes were strongly related to ICED scores: patients in Level 4 ICED scored 26.8 points lower in instrumental activities of daily living than patients in Level 1. After controlling for gender, age, education, and marital status, ICED remained a significant predictor of functional status at 1 year. Furthermore, differences among hospitals in functional outcomes disappeared when the ICED was included in the model to adjust for patient characteristics at the time of surgery. A measure of co-existent disease was crucial in explaining differences among hospitals in recovery from total hip replacement patients.