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Steinbeck V, Bischof AY, Schöner L, Langenberger B, Kuklinski D, Geissler A, Pross C, Busse R. Gender health gap pre- and post-joint arthroplasty: identifying affected patient-reported health domains. Int J Equity Health 2024; 23:44. [PMID: 38413981 PMCID: PMC10900674 DOI: 10.1186/s12939-024-02131-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/15/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND As patient-reported outcomes (PROs) gain prominence in hip and knee arthroplasty (HA and KA), studies indicate PRO variations between genders. Research on the specific health domains particularly impacted is lacking. Hence, we aim to quantify the gender health gap in PROs for HA/KA patients, differentiating between general health, health-related quality of life (HrQoL), physical functioning, pain, fatigue, and depression. METHODS The study included 3,693 HA patients (1,627 men, 2,066 women) and 3,110 KA patients (1,430 men, 1,680 women) receiving surgery between 2020 to 2021 in nine German hospitals, followed up until March 2022. Questionnaires used were: EQ-VAS, EQ-5D-5L, HOOS-PS, KOOS-PS, PROMIS-F-SF, PROMIS-D-SF, and a joint-specific numeric pain scale. PROs at admission, discharge, 12-months post-surgery, and the change from admission to 12-months (PRO-improvement) were compared by gender, tested for differences, and assessed using multivariate linear regressions. To enable comparability, PROs were transformed into z-scores (standard deviations from the mean). RESULTS Observed differences between genders were small in all health domains and differences reduced over time. Men reported significantly better health versus women pre-HA (KA), with a difference of 0.252 (0.224) standard deviations from the mean for pain, 0.353 (0.243) for fatigue (PROMIS-F-SF), 0.327 (0.310) for depression (PROMIS-D-SF), 0.336 (0.273) for functionality (H/KOOS-PS), 0.177 (0.186) for general health (EQ-VAS) and 0.266 (0.196) for HrQoL (EQ-5D-5L). At discharge, the gender health gap reduced and even disappeared for some health dimensions since women improved in health to a greater extent than men. No gender health gap was observed in most PRO-improvements and at month 12. CONCLUSIONS Men experiencing slightly better health than women in all health dimensions before surgery while experiencing similar health benefits 12-months post-surgery, might be an indicator of men receiving surgery inappropriately early, women unnecessarily late or both. As studies often investigate the PRO-improvement, they miss pre-surgery gender differences, which could be an important target for improvement initiatives in patient-centric care. Moreover, future research on cutoffs for meaningful between-group PRO differences per measurement time would aid the interpretation of gender health disparities. TRIAL REGISTRATION German Register for Clinical Trials, DRKS00019916, 26 November 2019.
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Affiliation(s)
- Viktoria Steinbeck
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Strasse Des 17 Juni 135, Berlin, 10623, Germany.
| | - Anja Yvonne Bischof
- School of Medicine, Chair of Health Economics, Policy and Management, University of St. Gallen, St. Gallen, Switzerland
| | - Lukas Schöner
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Strasse Des 17 Juni 135, Berlin, 10623, Germany
| | - Benedikt Langenberger
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Strasse Des 17 Juni 135, Berlin, 10623, Germany
| | - David Kuklinski
- School of Medicine, Chair of Health Economics, Policy and Management, University of St. Gallen, St. Gallen, Switzerland
| | - Alexander Geissler
- School of Medicine, Chair of Health Economics, Policy and Management, University of St. Gallen, St. Gallen, Switzerland
| | - Christoph Pross
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Strasse Des 17 Juni 135, Berlin, 10623, Germany
| | - Reinhard Busse
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Strasse Des 17 Juni 135, Berlin, 10623, Germany
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Jia H, Simpson S, Sathish V, Curran BP, Macias AA, Waterman RS, Gabriel RA. Development and benchmarking of machine learning models to classify patients suitable for outpatient lower extremity joint arthroplasty. J Clin Anesth 2023; 88:111147. [PMID: 37201387 DOI: 10.1016/j.jclinane.2023.111147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/06/2023] [Accepted: 05/09/2023] [Indexed: 05/20/2023]
Abstract
STUDY OBJECTIVE Performing hip or knee arthroplasty as an outpatient surgery has been shown to be operationally and financially beneficial for selected patients. By applying machine learning models to predict patients suitable for outpatient arthroplasty, health care systems can better utilize resources efficiently. The goal of this study was to develop predictive models for identifying patients likely to be discharged same-day following hip or knee arthroplasty. DESIGN Model performance was assessed with 10-fold stratified cross-validation, evaluated over baseline determined by the proportion of eligible outpatient arthroplasty over sample size. The models used for classification were logistic regression, support vector classifier, balanced random forest, balanced bagging XGBoost classifier, and balanced bagging LightGBM classifier. SETTING The patient records were sampled from arthroplasty procedures at a single institution from October 2013 to November 2021. PATIENTS The electronic intake records of 7322 knee and hip arthroplasty patients were sampled for the dataset. After data processing, 5523 records were kept for model training and validation. INTERVENTIONS None. MEASUREMENTS The primary measures for the models were the F1-score, area under the receiver operating characteristic curve (ROCAUC), and area under the precision-recall curve. To measure feature importance, the SHapley Additive exPlanations value (SHAP) were reported from the model with the highest F1-score. RESULTS The best performing classifier (balanced random forest classifier) achieved an F1-score of 0.347: an improvement of 0.174 over baseline and 0.031 over logistic regression. The ROCAUC for this model was 0.734. Using SHAP, the top determinant features of the model included patient sex, surgical approach, surgery type, and body mass index. CONCLUSIONS Machine learning models may utilize electronic health records to screen arthroplasty procedures for outpatient eligibility. Tree-based models demonstrated superior performance in this study.
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Affiliation(s)
- Haoyu Jia
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA; Division of Perioperative Informatics, Department of Anesthesiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Sierra Simpson
- Division of Perioperative Informatics, Department of Anesthesiology, University of California San Diego, La Jolla, CA 92093, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
| | - Varshini Sathish
- Division of Perioperative Informatics, Department of Anesthesiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Brian P Curran
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
| | - Alvaro A Macias
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
| | - Ruth S Waterman
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
| | - Rodney A Gabriel
- Division of Perioperative Informatics, Department of Anesthesiology, University of California San Diego, La Jolla, CA 92093, USA.
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Gimunová M, Vodička T, Bozděch M, Vespalec T. Changes in plantar pressure, contact area and contact time symmetry during the gait 4 weeks before and 12 and 24 weeks after unilateral total hip arthroplasty. Clin Biomech (Bristol, Avon) 2021; 89:105473. [PMID: 34482069 DOI: 10.1016/j.clinbiomech.2021.105473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Foot to ground pressure changes in total hip arthroplasty patients' gait are not widely described, although they are sensitive to gait abnormalities and the distribution of plantar pressures may differ before and after the surgery. This study aimed to analyse longitudinally differences in plantar pressure during gait in total hip arthroplasty patients compared to healthy controls. METHODS Eighteen males participated in this study. Eight males, who underwent unilateral total hip arthroplasty, participated at the data collection three times: 4 weeks before the surgery, 12 and 24 weeks after, and ten healthy controls. All participants were asked to walk over Emed platform. To compare differences between the affected and unaffected limbs, Kolmogorov-Smirnov test was used. Kruskal-Wallis test was used to compare the difference between total hip arthroplasty patients and healthy controls. FINDINGS Statistically significant differences between the affected and unaffected limb were observed only during the preoperative measurement in peak pressure at MH4 area and in the contact area at MH4 and big toe. When comparing total hip arthroplasty patients and controls, a difference in the contact time at MH2, MH3 and MH4 areas 12 weeks after surgery and at MH2 and MH4 24 weeks after the surgery were observed. INTERPRETATION The shorter contact time at forefoot areas may indicate an alteration in the propulsive phase of the gait of both the affected limb and unaffected limb in total hip arthroplasty patients as a result of decreased terminal hip extension during the stance phase described in previous studies.
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Affiliation(s)
- Marta Gimunová
- Masaryk University, Faculty of Sport Studies, Kamenice 753/5, 625 00 Brno, Czech Republic.
| | - Tomáš Vodička
- Masaryk University, Faculty of Sport Studies, Kamenice 753/5, 625 00 Brno, Czech Republic
| | - Michal Bozděch
- Masaryk University, Faculty of Sport Studies, Kamenice 753/5, 625 00 Brno, Czech Republic
| | - Tomáš Vespalec
- Masaryk University, Faculty of Sport Studies, Kamenice 753/5, 625 00 Brno, Czech Republic
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Fletcher AN, Mody KS, Adams SB, DeOrio JK, Easley ME, Nunley JA. Effect of Gender Differences on Patient-Reported Outcomes and Complications in Total Ankle Replacement. Foot Ankle Int 2021; 42:776-787. [PMID: 33517772 DOI: 10.1177/1071100720985292] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate gender differences in patient outcomes and complications following total ankle replacement (TAR). METHODS Consecutive patients who underwent primary TAR from July 2007 through May 2016 were prospectively followed and retrospectively reviewed. Demographic, operative, patient-reported outcomes (PROs), and complication data were collected and analyzed. PROs included the visual analog scale (VAS), 36-Item Short-Form Health Survey (SF-36), American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale, and Short Musculoskeletal Function Assessment (SMFA). A total of 475 patients were evaluated, including 248 males (52.2%) and 227 females (47.8%) with an average of 56.8 months follow-up. RESULTS Women were more likely to have inflammatory arthritis (13.7% vs 2.8%; P < .01) and significantly worse preoperative SF-36 total, SF-36 mental health component, AOFAS total, AOFAS pain, SMFA function, and SMFA bother scores (all P < .05). Both genders demonstrated significant improvement in PROs at 1, 2, and 5 years. The magnitude of improvement was similar between genders for all PROs (all P < .05) with the exception of SF-36 physical function, which was greater in men. Females underwent more nonrevision reoperations (32.2% vs 22.6%; P = .0191), but there was no significant difference in failure rates (male 7.3% vs female 3.5%; P = .07). The reoperation and failure rates at 2 years postoperation were 10.1% and 1.6% for men and 18.5% and 0.9% for women, respectively. CONCLUSION Women undergoing TAR were more likely to have worse preoperative PROs and higher rates of nonrevision reoperations, which remains true when controlling for their increased incidence of inflammatory arthritis. However, women reported similar improvements in PROs and had similar prosthetic survival rates as men. Increased understanding of these disparities, combined with gender-based interventions, may further advance patient outcomes. LEVEL OF EVIDENCE Level III, therapeutic, retrospective comparative series.
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Affiliation(s)
- Amanda N Fletcher
- Department of Orthopaedics, Duke University Medical Center, Durham, NC, USA
| | - Kush S Mody
- Drexel University College of Medicine & Columbia Business School, Philadelphia, PA, USA
| | - Samuel B Adams
- Department of Orthopaedics, Duke University Medical Center, Durham, NC, USA
| | - James K DeOrio
- Department of Orthopaedics, Duke University Medical Center, Durham, NC, USA
| | - Mark E Easley
- Department of Orthopaedics, Duke University Medical Center, Durham, NC, USA
| | - James A Nunley
- Department of Orthopaedics, Duke University Medical Center, Durham, NC, USA
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Elsamadicy AA, Freedman IG, Koo AB, David WB, Lee M, Kundishora AJ, Kuzmik GA, Gorrepati R, Hong CS, Kolb L, Laurans M, Abbed K. Influence of gender on discharge disposition after spinal fusion for adult spine deformity correction. Clin Neurol Neurosurg 2020; 194:105875. [DOI: 10.1016/j.clineuro.2020.105875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/20/2020] [Accepted: 04/26/2020] [Indexed: 01/11/2023]
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Abstract
The role of gender, race, and socioeconomic status in outcomes and satisfaction are reflected in patient-reported outcomes using measurement tools representing outcome domains. These domains include pain relief, physical and emotional functioning, adverse events, participant disposition, and patient satisfaction. Measurement tools exist for each of the outcomes in both acute and chronic pain. Patients with lower economic status have greater difficulty accessing care, are involved less in shared decision-making process, and are less satisfied with their care. Blacks, Hispanics, and Asians also have increased difficulty in accessing good quality care. Women have inferior outcomes after medical and surgical interventions.
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Affiliation(s)
- Natalie Kozlov
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Feinberg Pavilion, Suite 5-704, 251 E. Huron Street, Chicago, IL 60611, USA
| | - Honorio T Benzon
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Feinberg Pavilion, Suite 5-704, 251 E. Huron Street, Chicago, IL 60611, USA.
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No association between preoperative physical activity level and time to return to work in patients after total hip or knee arthroplasty: A prospective cohort study. PLoS One 2019; 14:e0221932. [PMID: 31479493 PMCID: PMC6719850 DOI: 10.1371/journal.pone.0221932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 08/19/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose It is important for patients of working age to resume work after total hip or knee arthroplasty (THA/TKA). A higher preoperative level of physical activity is presumed to lead to a better or faster recovery. Aim is to examine the association between preoperative physical activity (PA) level (total and leisure-time) and time to return-to-work (RTW). Methods A prospective multicenter survey study. Time to RTW was defined as the length of time (days) from surgery to RTW. PA level was assessed with the SQUASH questionnaire. Questionnaires were filled in before surgery and 6 weeks and 3, 6 and 12 months post-surgery. Multiple regression analyses were conducted separately for THA and TKA patients. Results 243 patients were enrolled. Median age was 56 years; 58% had undergone a THA. Median time to RTW was 85 (THA) and 93 (TKA) days. In the multiple regression analysis, neither preoperative total PA level nor leisure-time PA level were significantly associated with time to RTW. Conclusions Preoperative physical activity level is not associated with a shorter time to RTW in either THA or TKA patients. Neither preoperative total PA level nor leisure-time PA level showed an association with time to RTW, even after adjusting for covariates. Trial registry Dutch Trial Register: NTR3497.
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Wada O, Asai T, Hiyama Y, Nitta S, Mizuno K. Root mean square of lower trunk acceleration during walking in patients with unilateral total hip replacement. Gait Posture 2017; 58:19-22. [PMID: 28704684 DOI: 10.1016/j.gaitpost.2017.07.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 07/03/2017] [Accepted: 07/07/2017] [Indexed: 02/02/2023]
Abstract
Although several studies have described abnormal trunk motion before and after total hip arthroplasty (THA) surgery, few studies have examined trunk motion using accelerometry. The aim of this study was to determine whether abnormal trunk motion persisted after THA using accelerometry. A total of 24 female patients (61.0±6.9years) and 20 healthy female subjects (59.9±6.8years) participated in this study. Patients were assessed at 1 month prior to surgery and 12 months after surgery. Trunk acceleration during gait was measured using a triaxial accelerometer attached to the L3 spinous process. We calculated the root mean square (RMS) and RMS ratio (RMSR) in the vertical (VT), medio-lateral (ML), and anterior-posterior (AP) directions. Results revealed that the RMS in the VT and AP directions postoperatively was greater than that preoperatively, whereas there was no difference in the RMS in the ML direction. In addition, the preoperative RMSR in the ML direction was significantly greater compared with that of healthy individuals and the postoperative RMSR. There was no difference in the RMSR in the ML direction between healthy individuals and postoperatively. These findings suggested that the trunk motion in the frontal plane prior to surgery had improved and was comparable to that of healthy individuals following THA.
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Affiliation(s)
- Osamu Wada
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan.
| | - Tsuyoshi Asai
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, 518 Ikawadanicho, Arise, Nishi-ku, Kobe, Hyogo 651-2180, Japan
| | - Yoshinori Hiyama
- Department of Physical Therapy, School of Health Sciences, Tokyo University of Technology, 5-23-22, Nishikamata, Ota-ku, Tokyo, Japan
| | - Shingo Nitta
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
| | - Kiyonori Mizuno
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
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Elsamadicy AA, Reddy GB, Nayar G, Sergesketter A, Zakare-Fagbamila R, Karikari IO, Gottfried ON. Impact of Gender Disparities on Short-Term and Long-Term Patient Reported Outcomes and Satisfaction Measures After Elective Lumbar Spine Surgery: A Single Institutional Study of 384 Patients. World Neurosurg 2017; 107:952-958. [PMID: 28743671 DOI: 10.1016/j.wneu.2017.07.082] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/14/2017] [Accepted: 07/15/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a paucity of data determining the impact that gender disparities have on spine outcomes, particularly perception of health and satisfaction. The aim of this study was to determine whether there is a difference in 3-month and 1-year patient-reported outcomes and satisfaction after elective lumbar spine surgery. METHODS This was a retrospectively analyzed study from a maintained prospective database of 384 patients who underwent elective lumbar spine surgery. Patients were categorized by gender (men, n = 199; women, n = 185). Patient-reported outcome instruments (Oswestry disability index, visual analogue scale-back pain/leg pain, EuroQol visual analogue scale, and EuroQol 5 dimensions questionnaire) were completed before surgery, then at 3 and 12 months after surgery along with patient satisfaction measures. RESULTS Baseline patient demographics, comorbidities, and operative variables were similar between both cohorts. The female cohort had a slightly longer hospital stay than male cohort (P = 0.007). Baseline patient-reported outcome measures were different between both cohorts, with female patients having more Oswestry disability index (23.8 vs. 20.4; P ≤ 0.0001) and visual analogue scale-back pain (7.2 vs. 6.2; P = 0.0004), and a lower EuroQol 5 dimensions questionnaire (0.34 vs. 0.49; P = 0.0001) compared with the male cohort. At 1-year follow-up, the male cohort had a significantly more mean change in visual analogue scale-leg pain (-3.9 vs. -2.8; P = 0.04) and trended to have more mean change in visual analogue scale-back pain (-3.4 vs. -2.5; P = 0.06) and EuroQol visual analogue scale (8.6 vs. 3.4; P = 0.054) scores compared with the female cohort. At 1-year a significantly more portion in the male cohort found that surgery met their expectations compared with the female cohort (65.0% vs. 49.5%; P = 0.02). CONCLUSIONS Our study suggests that there may be differences in perception of health, pain, and disability between men and women at baseline, short-term and long-term follow-up that may influence overall patient satisfaction.
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Affiliation(s)
- Aladine A Elsamadicy
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Gireesh B Reddy
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Gautum Nayar
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Amanda Sergesketter
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Isaac O Karikari
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Oren N Gottfried
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
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