Succes van een ingreep bepaald door patient gerelateerde factoren.

In de augustus editie van de Journal of Bone and Joint Surgery verscheen een artikel waarin de factoren werden bekeken die een ingreep (in dit geval een totale knieprothese) tot een succes maakten.

Het bleek dat patientgerelateerde factoren belangrijker waren dan techniek of chirurg gerelateerde factoren. Gekende factoren zijn bijvoorbeeld de algehele gezondheidstoestand, de aanwezigheid van angst of depressie en de wijze van omgaan met problemen (coping).

In deze tijden waarin de verzekeraars steeds meer gaan sturen op Patient Related Outcome Measures (PROM's) is het belangrijk dat de verdeling van de beschikbare budgetten niet alleen gebeurt op basis van economische motieven en uitkomstmaten zoals PROM's, maar dat ook patient gerelateerde facoren worden meegenomen in beslissingen.

J Bone Joint Surg Br. 2012 Aug;94(8):1058-66.

The effect of surgical factors on early patient-reported outcome measures (PROMS) following total knee replacement.

Baker PN, Deehan DJ, Lees D, Jameson S, Avery PJ, Gregg PJ, Reed MR.

Institute of Cellular Medicine, Medical school, Newcastle University, Framlington place, Newcastle upon Tyne NE1 7RU, UK.

Patient-reported outcome measures (PROMs) are increasingly being used to assess functional outcome and patient satisfaction. They provide a framework for comparisons between surgical units, and individual surgeons for benchmarking and financial remuneration. Better performance may bring the reward of more customers as patients and commissioners seek out high performers for their elective procedures.

Using National Joint Registry (NJR) data linked to PROMs we identified 22 691 primary total knee replacements (TKRs) undertaken for osteoarthritis in England and Wales between August 2008 and February 2011, and identified the surgical factors that influenced the improvements in the Oxford knee score (OKS) and EuroQol-5D (EQ-5D) assessment using multiple regression analysis.

After correction for patient factors the only surgical factors that influenced PROMs were implant brand and hospital type (both p < 0.001). However, the effects of surgical factors upon the PROMs were modest compared with patient factors. For both the OKS and the EQ-5D the most important factors influencing the improvement in PROMs were the corresponding pre-operative score and the patient's general health status.

Despite having only a small effect on PROMs, this study has shown that both implant brand and hospital type do influence reported subjective functional scores following TKR.

In the current climate of financial austerity, proposed performance-based remuneration and wider patient choice, it would seem unwise to ignore these effects and the influence of a range of additional patient factors.