دورية أكاديمية
Unicompartmental compared with total knee replacement for patients with multimorbidities: a cohort study using propensity score stratification and inverse probability weighting
| العنوان: | Unicompartmental compared with total knee replacement for patients with multimorbidities: a cohort study using propensity score stratification and inverse probability weighting |
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| المؤلفون: | Albert Prats-Uribe, Spyros Kolovos, Klara Berencsi, Andrew Carr, Andrew Judge, Alan Silman, Nigel Arden, Irene Petersen, Ian J Douglas, J Mark Wilkinson, David Murray, Jose M Valderas, David J Beard, Sarah E Lamb, M Sanni Ali, Rafael Pinedo-Villanueva, Victoria Y Strauss, Daniel Prieto-Alhambra |
| المصدر: | Health Technology Assessment, Vol 25, Iss 66 (2021) |
| بيانات النشر: | NIHR Journals Library, 2021. |
| سنة النشر: | 2021 |
| المجموعة: | LCC:Medical technology |
| مصطلحات موضوعية: | arthroplasty, replacement, knee, propensity score, patient reported outcome measures, comparative effectiveness research, Medical technology, R855-855.5 |
| الوصف: | Background: Although routine NHS data potentially include all patients, confounding limits their use for causal inference. Methods to minimise confounding in observational studies of implantable devices are required to enable the evaluation of patients with severe systemic morbidity who are excluded from many randomised controlled trials. Objectives: Stage 1 – replicate the Total or Partial Knee Arthroplasty Trial (TOPKAT), a surgical randomised controlled trial comparing unicompartmental knee replacement with total knee replacement using propensity score and instrumental variable methods. Stage 2 – compare the risk benefits and cost-effectiveness of unicompartmental knee replacement with total knee replacement surgery in patients with severe systemic morbidity who would have been ineligible for TOPKAT using the validated methods from stage 1. Design: This was a cohort study. Setting: Data were obtained from the National Joint Registry database and linked to hospital inpatient (Hospital Episode Statistics) and patient-reported outcome data. Participants: Stage 1 – people undergoing unicompartmental knee replacement surgery or total knee replacement surgery who met the TOPKAT eligibility criteria. Stage 2 – participants with an American Society of Anesthesiologists grade of ≥ 3. Intervention: The patients were exposed to either unicompartmental knee replacement surgery or total knee replacement surgery. Main outcome measures: The primary outcome measure was the postoperative Oxford Knee Score. The secondary outcome measures were 90-day postoperative complications (venous thromboembolism, myocardial infarction and prosthetic joint infection) and 5-year revision risk and mortality. The main outcome measures for the health economic analysis were health-related quality of life (EuroQol-5 Dimensions) and NHS hospital costs. Results: In stage 1, propensity score stratification and inverse probability weighting replicated the results of TOPKAT. Propensity score adjustment, propensity score matching and instrumental variables did not. Stage 2 included 2256 unicompartmental knee replacement patients and 57,682 total knee replacement patients who had severe comorbidities, of whom 145 and 23,344 had linked Oxford Knee Scores, respectively. A statistically significant but clinically irrelevant difference favouring unicompartmental knee replacement was observed, with a mean postoperative Oxford Knee Score difference of |
| نوع الوثيقة: | article |
| وصف الملف: | electronic resource |
| اللغة: | English |
| تدمد: | 1366-5278 2046-4924 |
| العلاقة: | https://doaj.org/toc/1366-5278Test; https://doaj.org/toc/2046-4924Test |
| DOI: | 10.3310/hta25660 |
| الوصول الحر: | https://doaj.org/article/08119d74bbdd4f1f89c190f51944fe4cTest |
| رقم الانضمام: | edsdoj.08119d74bbdd4f1f89c190f51944fe4c |
| قاعدة البيانات: | Directory of Open Access Journals |
Full Text Finder | تدمد: | 13665278 20464924 |
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| DOI: | 10.3310/hta25660 |