Post-operative determinants of chronic pain after primary knee replacement surgery: analysis of data on 258,386 patients from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR)
<strong>Objective: </strong>To identify post-operative risk factors for the development of chronic pain after knee replacement. <br><strong>Design: </strong>Primary knee replacements in persons aged ≥18 years between April 2008 and December 2016 from the National Joint...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
Elsevier
2021
|
| _version_ | 1797088032930660352 |
|---|---|
| author | Khalid, S Mohammad, H Gooberman-Hill, R Garriga-Fuentes, C Pinedo Villanueva, R Arden, N Price, A Wylde, V Peters, TJ Blom, A Judge, AD |
| author_facet | Khalid, S Mohammad, H Gooberman-Hill, R Garriga-Fuentes, C Pinedo Villanueva, R Arden, N Price, A Wylde, V Peters, TJ Blom, A Judge, AD |
| author_sort | Khalid, S |
| collection | OXFORD |
| description | <strong>Objective: </strong>To identify post-operative risk factors for the development of chronic pain after knee replacement.
<br><strong>Design: </strong>Primary knee replacements in persons aged ≥18 years between April 2008 and December 2016 from the National Joint Registry, linked with English Hospital Episode Statistics data, and Patient Reported Outcome Measures. The outcome was chronic pain 6-months after surgery (Oxford Knee pain score). Logistic regression modelling identified risk factors for chronic pain outcome.
<br><strong>Results:</strong> 258,386 patients; 56.7% women; average age 70.1 years (SD ±8.8 years). 43,702 (16.9%) were identified as having chronic pain 6-months post-surgery. Within 3 months of surgery complications were uncommon: intra-operative complications 1,224 (0.5%); ≥1 medical complication 6,073 (2.4%)); 32,930 (12.7%) hospital readmissions; 3,848 (1.5%) re-operation; 835 (0.3%) revision. Post-surgical risk factors of chronic pain were: mechanical complication of prosthesis odds ratio (OR) 1.56 (95% Confidence Interval 1.35, 1.80); surgical site infection OR 1.13 (0.99, 1.29); readmission OR 1.47 (1.42, 1.52); re-operation OR 1.39 (1.27, 1.51); revision OR 1.92 (1.64, 2.25); length of stay e.g. 6+ vs. <2 days OR 1.48 (1.35, 1.63), blood transfusion OR 0.47 (0.26, 0.86) and myocardial infarction OR 0.69 (0.49, 0.97). Discriminatory ability of the model was only fair (c-statistic 0.71) indicating that post-surgical predictors explain a limited amount of variability in chronic pain.
<br><strong>Conclusions: </strong>We identified a number of post-operative factors relating to the operation and early recovery that are associated with chronic pain following primary knee replacement. The model had weak discriminatory ability indicating that there remains considerable unexplained variability in chronic pain outcome. |
| first_indexed | 2024-03-07T02:44:06Z |
| format | Journal article |
| id | oxford-uuid:ab745f72-6046-4cad-b8ff-d09625e91af7 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T02:44:06Z |
| publishDate | 2021 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:ab745f72-6046-4cad-b8ff-d09625e91af72022-03-27T03:22:03ZPost-operative determinants of chronic pain after primary knee replacement surgery: analysis of data on 258,386 patients from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR)Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:ab745f72-6046-4cad-b8ff-d09625e91af7EnglishSymplectic ElementsElsevier2021Khalid, SMohammad, HGooberman-Hill, RGarriga-Fuentes, CPinedo Villanueva, RArden, NPrice, AWylde, VPeters, TJBlom, AJudge, AD<strong>Objective: </strong>To identify post-operative risk factors for the development of chronic pain after knee replacement. <br><strong>Design: </strong>Primary knee replacements in persons aged ≥18 years between April 2008 and December 2016 from the National Joint Registry, linked with English Hospital Episode Statistics data, and Patient Reported Outcome Measures. The outcome was chronic pain 6-months after surgery (Oxford Knee pain score). Logistic regression modelling identified risk factors for chronic pain outcome. <br><strong>Results:</strong> 258,386 patients; 56.7% women; average age 70.1 years (SD ±8.8 years). 43,702 (16.9%) were identified as having chronic pain 6-months post-surgery. Within 3 months of surgery complications were uncommon: intra-operative complications 1,224 (0.5%); ≥1 medical complication 6,073 (2.4%)); 32,930 (12.7%) hospital readmissions; 3,848 (1.5%) re-operation; 835 (0.3%) revision. Post-surgical risk factors of chronic pain were: mechanical complication of prosthesis odds ratio (OR) 1.56 (95% Confidence Interval 1.35, 1.80); surgical site infection OR 1.13 (0.99, 1.29); readmission OR 1.47 (1.42, 1.52); re-operation OR 1.39 (1.27, 1.51); revision OR 1.92 (1.64, 2.25); length of stay e.g. 6+ vs. <2 days OR 1.48 (1.35, 1.63), blood transfusion OR 0.47 (0.26, 0.86) and myocardial infarction OR 0.69 (0.49, 0.97). Discriminatory ability of the model was only fair (c-statistic 0.71) indicating that post-surgical predictors explain a limited amount of variability in chronic pain. <br><strong>Conclusions: </strong>We identified a number of post-operative factors relating to the operation and early recovery that are associated with chronic pain following primary knee replacement. The model had weak discriminatory ability indicating that there remains considerable unexplained variability in chronic pain outcome. |
| spellingShingle | Khalid, S Mohammad, H Gooberman-Hill, R Garriga-Fuentes, C Pinedo Villanueva, R Arden, N Price, A Wylde, V Peters, TJ Blom, A Judge, AD Post-operative determinants of chronic pain after primary knee replacement surgery: analysis of data on 258,386 patients from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) |
| title | Post-operative determinants of chronic pain after primary knee replacement surgery: analysis of data on 258,386 patients from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) |
| title_full | Post-operative determinants of chronic pain after primary knee replacement surgery: analysis of data on 258,386 patients from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) |
| title_fullStr | Post-operative determinants of chronic pain after primary knee replacement surgery: analysis of data on 258,386 patients from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) |
| title_full_unstemmed | Post-operative determinants of chronic pain after primary knee replacement surgery: analysis of data on 258,386 patients from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) |
| title_short | Post-operative determinants of chronic pain after primary knee replacement surgery: analysis of data on 258,386 patients from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) |
| title_sort | post operative determinants of chronic pain after primary knee replacement surgery analysis of data on 258 386 patients from the national joint registry for england wales northern ireland and the isle of man njr |
| work_keys_str_mv | AT khalids postoperativedeterminantsofchronicpainafterprimarykneereplacementsurgeryanalysisofdataon258386patientsfromthenationaljointregistryforenglandwalesnorthernirelandandtheisleofmannjr AT mohammadh postoperativedeterminantsofchronicpainafterprimarykneereplacementsurgeryanalysisofdataon258386patientsfromthenationaljointregistryforenglandwalesnorthernirelandandtheisleofmannjr AT goobermanhillr postoperativedeterminantsofchronicpainafterprimarykneereplacementsurgeryanalysisofdataon258386patientsfromthenationaljointregistryforenglandwalesnorthernirelandandtheisleofmannjr AT garrigafuentesc postoperativedeterminantsofchronicpainafterprimarykneereplacementsurgeryanalysisofdataon258386patientsfromthenationaljointregistryforenglandwalesnorthernirelandandtheisleofmannjr AT pinedovillanuevar postoperativedeterminantsofchronicpainafterprimarykneereplacementsurgeryanalysisofdataon258386patientsfromthenationaljointregistryforenglandwalesnorthernirelandandtheisleofmannjr AT ardenn postoperativedeterminantsofchronicpainafterprimarykneereplacementsurgeryanalysisofdataon258386patientsfromthenationaljointregistryforenglandwalesnorthernirelandandtheisleofmannjr AT pricea postoperativedeterminantsofchronicpainafterprimarykneereplacementsurgeryanalysisofdataon258386patientsfromthenationaljointregistryforenglandwalesnorthernirelandandtheisleofmannjr AT wyldev postoperativedeterminantsofchronicpainafterprimarykneereplacementsurgeryanalysisofdataon258386patientsfromthenationaljointregistryforenglandwalesnorthernirelandandtheisleofmannjr AT peterstj postoperativedeterminantsofchronicpainafterprimarykneereplacementsurgeryanalysisofdataon258386patientsfromthenationaljointregistryforenglandwalesnorthernirelandandtheisleofmannjr AT bloma postoperativedeterminantsofchronicpainafterprimarykneereplacementsurgeryanalysisofdataon258386patientsfromthenationaljointregistryforenglandwalesnorthernirelandandtheisleofmannjr AT judgead postoperativedeterminantsofchronicpainafterprimarykneereplacementsurgeryanalysisofdataon258386patientsfromthenationaljointregistryforenglandwalesnorthernirelandandtheisleofmannjr |