Do Patients Accurately Represent Their Experiences After Hip and Knee Replacements?

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2021 Feb 22

PMID 33614344

Authors

Thomas Ashdown

Chang Park

Fahima Begum

Anna Panagiotidou

Kapil Sugand

Sherif El-Tawil

Affiliations

Soon will be listed here.

Abstract

Background To investigate discrepancies, if any, between the complications that patients report on the patient-reported outcome measures (PROMs) questionnaire and what is formally recorded in their medical records. Methodology A retrospective analysis of PROMs-reported complications was performed at a single elective center for all patients who had an elective primary total knee or hip replacement between April 2016 and March 2017. Corresponding patient medical records were then analyzed to correlate the PROMs with any documentation of postoperative complications, which similar to the PROMs data were categorized into wound complications, urinary complications, readmission, and further operative procedures. Results A set of 54 complete patient records were compared to the corresponding PROMs data. The combined overall positive predictive value was 0.47 while the overall negative predictive value was 0.91. Concordance between patients and the medical records was 70.4% for wound complication, 66.7% for urinary complications, 83.3% for readmission, and 96.3% for reoperation. Conclusion PROMs data are becoming increasingly important in auditing and planning healthcare provision. This study highlights a significant level of discrepancy between the PROMs-reported complication rates and those documented in the medical records. There is a visible disparity between patient perception and the medical definition of postoperative complications. Further patient education and empowerment are required in preparation for arthroplasty.

References

Alazzawi S, Bardakos N, Hadfield S, Butt U, Beer Z, Field R . Patient-reported complications after elective joint replacement surgery: are they correct?. J Bone Joint Surg Br. 2012; 94(8):1120-5. DOI: 10.1302/0301-620X.94B8.29040. View

Howes B, Clarke P, Cook T . The National Joint Registry may fail to collect accurate, validated anaesthetic data. Anaesthesia. 2009; 64(6):694-5. DOI: 10.1111/j.1365-2044.2009.05956.x. View

Sajun S, Albutt K, Moosajee U, Drevin G, Mukhopadhyay S, Samad L . Self-Diagnosis of Surgical Site Infections: Lessons from a tertiary care centre in Karachi, Pakistan. Pak J Med Sci. 2020; 36(1):S55-S60. PMC: 6943118. DOI: 10.12669/pjms.36.ICON-Suppl.1716. View

Black N . Patient reported outcome measures could help transform healthcare. BMJ. 2013; 346:f167. DOI: 10.1136/bmj.f167. View

Slankamenac K, Graf R, Puhan M, Clavien P . Perception of surgical complications among patients, nurses and physicians: a prospective cross-sectional survey. Patient Saf Surg. 2011; 5(1):30. PMC: 3284430. DOI: 10.1186/1754-9493-5-30. View

Dawson J, Fitzpatrick R, Murray D, Carr A . Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br. 1998; 80(1):63-9. DOI: 10.1302/0301-620x.80b1.7859. View

Whitby M, Mclaws M, Collopy B, Looke D, Doidge S, Henderson B . Post-discharge surveillance: can patients reliably diagnose surgical wound infections?. J Hosp Infect. 2002; 52(3):155-60. DOI: 10.1053/jhin.2002.1275. View

. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy. 1990; 16(3):199-208. DOI: 10.1016/0168-8510(90)90421-9. View

Dushey C, Bornstein L, Alexiades M, Westrich G . Short-term coagulation complications following total knee arthroplasty: a comparison of patient-reported and surgeon-verified complication rates. J Arthroplasty. 2011; 26(8):1338-42. DOI: 10.1016/j.arth.2010.11.007. View

10.

Sabah S, Henckel J, Cook E, Whittaker R, Hothi H, Pappas Y . Validation of primary metal-on-metal hip arthroplasties on the National Joint Registry for England, Wales and Northern Ireland using data from the London Implant Retrieval Centre: a study using the NJR dataset. Bone Joint J. 2015; 97-B(1):10-8. PMC: 4548488. DOI: 10.1302/0301-620X.97B1.35279. View

11.

Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster J . Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am. 2004; 86(5):963-74. DOI: 10.2106/00004623-200405000-00012. View

12.

Greenbaum J, Bornstein L, Lyman S, Alexiades M, Westrich G . The validity of self-report as a technique for measuring short-term complications after total hip arthroplasty in a joint replacement registry. J Arthroplasty. 2011; 27(7):1310-5. DOI: 10.1016/j.arth.2011.10.031. View

13.

Middleton R, Wilson H, Alvand A, Abram S, Bottomley N, Jackson W . Outcome-based commissioning of knee arthroplasty in the NHS: system error in a national monitoring programme and the unintended consequences on achieving the Best Practice Tariff. Bone Joint J. 2018; 100-B(12):1572-1578. DOI: 10.1302/0301-620X.100B12.BJJ-2018-0324.R1. View

14.

Timperley A, Haddad F . The transparency agenda and the orthopaedic data revolution. Bone Joint J. 2013; 95-B(9):1153-5. DOI: 10.1302/0301-620X.95B9.32853. View

15.

Murray D, Fitzpatrick R, Rogers K, Pandit H, Beard D, Carr A . The use of the Oxford hip and knee scores. J Bone Joint Surg Br. 2007; 89(8):1010-4. DOI: 10.1302/0301-620X.89B8.19424. View

16.

Heo S, Naylor J, Harris I, Churches T . Reliability of patient-reported complications following hip or knee arthroplasty procedures. BMC Med Res Methodol. 2019; 19(1):15. PMC: 6330452. DOI: 10.1186/s12874-018-0645-0. View

17.

Lingard E, Wright E, Sledge C . Pitfalls of using patient recall to derive preoperative status in outcome studies of total knee arthroplasty. J Bone Joint Surg Am. 2001; 83(8):1149-56. DOI: 10.2106/00004623-200108000-00003. View

18.

Smith A, Dieppe P, Vernon K, Porter M, Blom A . Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales. Lancet. 2012; 379(9822):1199-204. DOI: 10.1016/S0140-6736(12)60353-5. View

19.

Richter V, Cohen M, Benenson S, Almogy G, Brezis M . Patient Self-Assessment of Surgical Site Infection is Inaccurate. World J Surg. 2017; 41(8):1935-1942. DOI: 10.1007/s00268-017-3974-y. View

20.

Ho A, Purdie C, Tirosh O, Tran P . Improving the response rate of patient-reported outcome measures in an Australian tertiary metropolitan hospital. Patient Relat Outcome Meas. 2019; 10:217-226. PMC: 6628207. DOI: 10.2147/PROM.S162476. View