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Predicting Dissatisfaction Following Total Hip Arthroplasty Using A Bayesian Model Averaging (Bma) Approach: Results From The Australian Arthroplasty Clinical Outcomes Registry (Acorn)

Predicting Dissatisfaction Following Total Hip Arthroplasty Using A Bayesian Model Averaging (Bma) Approach: Results From The Australian Arthroplasty Clinical Outcomes Registry (Acorn)

Jan Peter Van Meirhaeghe, MD, BELGIUM Rob Molnar, MBBS, AUSTRALIA Sam Adie, BSc(Med) MBBS MSpMed MPH PhD FRACS, AUSTRALIA

Sydney Orthopaedic Trauma and Reconstructive Surgery (SOTRS), Sydney, NSW, AUSTRALIA


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Summary: Our study confirms the high rates of patient satisfaction following THA, with post-operative complications being the only determinant of dissatisfaction. Optimization of patients prior to surgery may further improve satisfaction rates after THA.


Background

Total Hip Arthroplasty (THA) provides excellent pain relief and improved function in patients with painful hip arthritis. A small proportion of patients are dissatisfied with the surgical outcome. The aim of this study was to identify rates and predictors of dissatisfaction following THA.

Methods

Data was collected prospectively from the Australian Arthroplasty Clinical Outcomes Registry database (ACORN) between 2014 and 2016 from 2096 patients who underwent THA. Data included baseline demographic data, patient reported outcome measures (PROMs) and post-operative clinical outcomes. Eighteen predefined variables were analyzed. PROMs included full Oxford Hip Score (OHS), EQ5D and patient satisfaction. A Bayesian Model Averaging (BMA) approach was used to build the best predictive model for dissatisfaction. Multiple logistic regression techniques were applied to quantify the effect size of the best model. Missing data was accounted for by multiple imputation.

Results

At six months following THA, 95.4% of patients (n=2000) were satisfied with surgical outcome and 4.6% (n=96) were dissatisfied. The only variable that was significantly associated with dissatisfaction after THA was ‘complications after discharge’. This result was consistent for both the complete data set and the imputed data analysis (odds ratio 4.78, 95% confidence interval 2.60 - 8.80, p < 0.001 and odds ratio 3.8, 95% confidence interval 2.60 - 5.60, p < 0.001, respectively).

Conclusion

Our study confirms the high rates of patient satisfaction following THA, with post-operative complications being the only determinant of dissatisfaction. Optimization of patients prior to surgery may further improve satisfaction rates after THA.


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