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Patient-reported Outcome in Surgically Treated Pelvic Ring Injuries at 5 Years Post-surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
2019 (English)In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, article id 1457496919877583Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND AND AIMS: Long-term prospective data on patient-reported outcome after surgical treatment of pelvic ring injuries are scarce. This study aimed at describing results at 5 years post-surgery using validated outcome measures.

PATIENTS AND METHODS: Patients admitted for surgical treatment of pelvic ring injuries were prospectively included and asked to report their outcome at 1, 2 and 5 years post-surgery using two patient-reported outcome measures: the generic Short-Form 36 and the condition-specific pelvic discomfort index. Data were evaluated using mixed-effects linear models.

RESULTS: There were 108 patients (68 males and 40 females), mean age 38 years. Injury type according to the AO/OTA-classification was B-type in 68 patients and C-type in 40 patients. No domain of the Short-Form 36 reached norm values at 5 years post-surgery. Females reported a worse outcome than males concerning general health (p < 0.01) at 5 years. Recovery of physical function (p < 0.01), mental health (p = 0.04), and pain (p = 0.01) was observed for males at 5 years compared to earlier assessments, while females on the contrary described more pain at this time-point (p = 0.03). Mean pelvic discomfort index at 5 years was 27, indicating moderate residual pelvic discomfort overall. Males reported less pelvic discomfort than females at 5 years (p = 0.02) and improved when compared to results at 2 years (p = 0.02), while females did not. Influence of age, fracture type, and presence of associated injuries on patient-reported outcome was limited.

CONCLUSION: Surgically treated pelvic ring injuries are associated with long-standing negative effects on patient-reported outcome. Males report a better outcome than females at 5 years post-surgery.

Place, publisher, year, edition, pages
2019. article id 1457496919877583
Keywords [en]
Pelvic ring injuries, Short-Form 36, orthopedic surgery, patient-reported outcome, patient-reported outcome measures, pelvic discomfort index, trauma
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:uu:diva-403813DOI: 10.1177/1457496919877583PubMedID: 31537176OAI: oai:DiVA.org:uu-403813DiVA, id: diva2:1391471
Available from: 2020-02-04 Created: 2020-02-04 Last updated: 2020-02-24Bibliographically approved
In thesis
1. Surgical Treatment of Pelvic Ring Injuries and Acetabular Fractures: Aspects on Patient-reported Outcome
Open this publication in new window or tab >>Surgical Treatment of Pelvic Ring Injuries and Acetabular Fractures: Aspects on Patient-reported Outcome
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the present thesis was to study the patient perspective on outcome following surgical treatment of pelvic ring injuries and acetabular fractures. All studies were based on patients treated for such injuries at the Department of Orthopaedics, Uppsala University Hospital, Sweden.

In Study I, a patient-reported outcome measure to provide condition-specific information regarding outcome after surgical treatment of pelvic ring injuries was developed. Seventy-three patients were asked to complete a questionnaire at three time points during follow-up. Evaluation of data resulted in the Pelvic Discomfort Index (PDI). This instrument is comprised of six questions regarding residual problems from the pelvic region with respect to pain, walking, hip motion, leg numbness, sexual life and the operation scar.

The influence of the time-point post-surgery at which patients with surgically treated pelvic ring injuries or acetabular fractures estimate their pre-traumatic state was examined in study II. Seventy-three patients assessed their pre-traumatic status at three time-points post-surgery. It was found that pre-traumatic quality of life was high and comparable to a reference population. Pre-existing discomfort from the pelvic region was uncommon. A tendency for patients to estimate a better pre-traumatic status when assessments were delayed was observed.

The objective of Study III was to compare outcome after surgical treatment of complex acetabular fractures in the elderly using either the combined hip procedure, consisting of open reduction and internal fixation (ORIF) in conjunction with an acute total hip arthroplasty, or ORIF alone with respect to mortality, need for secondary surgery and patient-reported outcome. Thirteen patients treated with the CHP were compared to 14 patients with similar fracture patterns treated with ORIF alone. The CHP conferred a markedly reduced need for secondary surgical procedures while no differences in perioperative mortality or patient-reported outcome could be demonstrated.

Patient-reported outcome at five years following surgical treatment of pelvic ring injury was evaluated in study IV. The consequences of these injuries were found to be substantial and long-standing. Females reported a worse outcome than males, while influence of variables age, injury type and presence of associated injuries was limited.

In Study V, patient experiences of life following treatment for pelvic ring injury was explored. Semi-structured interviews were conducted with ten patients at a median of 11 years after injury and analyzed using inductive content analysis. Patients described a heterogenous outcome, with residual impairment ranging from virtually none to severe disability. A need for adequate patient information and individual assessments of patients was noted.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2020. p. 53
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1643
Keywords
Pelvic ring injuries, acetabular fractures, patient.reported outcome, surgical treatment, PDI, SF-36
National Category
Orthopaedics
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-404264 (URN)978-91-513-0887-6 (ISBN)
Public defence
2020-04-23, H:son Holmdahlssalen, Akademiska sjukhuset, ing 100, 2 tr, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2020-03-18 Created: 2020-02-24 Last updated: 2020-03-19

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