Risk factors associated with poor pain outcomes following primary knee replacement surgery: Analysis of data from the clinical practice research datalink, hospital episode statistics and patient reported outcomes as part of the STAR research programme

Hasan Raza Mohammad; Rachael Gooberman-Hill; Antonella Delmestri; John Broomfield; Rita Patel; Joerg Huber; Cesar Garriga; Christopher Eccleston; Rafael Pinedo-Villanueva; Tamer T. Malak; Nigel Arden; Andrew Price; Vikki Wylde; Tim J. Peters; Ashley W. Blom; Andrew Judge

doi:10.1371/journal.pone.0261850

Risk factors associated with poor pain outcomes following primary knee replacement surgery: Analysis of data from the clinical practice research datalink, hospital episode statistics and patient reported outcomes as part of the STAR research programme

Hasan Raza Mohammad, Rachael Gooberman-Hill, Antonella Delmestri, John Broomfield, Rita Patel, Joerg Huber, Cesar Garriga, Christopher Eccleston, Rafael Pinedo-Villanueva, Tamer T. Malak, Nigel Arden, Andrew Price, Vikki Wylde, Tim J. Peters, Ashley W. Blom, Andrew Judge

Research output: Contribution to journal › Article › peer-review

8 Citations (SciVal)

Abstract

Objective Identify risk factors for poor pain outcomes six months after primary knee replacement surgery. Methods Observational cohort study on patients receiving primary knee replacement from the UK Clinical Practice Research Datalink, Hospital Episode Statistics and Patient Reported Outcomes. A wide range of variables routinely collected in primary and secondary care were identified as potential predictors of worsening or only minor improvement in pain, based on the Oxford Knee Score pain subscale. Results are presented as relative risk ratios and adjusted risk differences (ARD) by fitting a generalized linear model with a binomial error structure and log link function. Results Information was available for 4,750 patients from 2009 to 2016, with a mean age of 69, of whom 56.1% were female. 10.4% of patients had poor pain outcomes. The strongest effects were seen for pre-operative factors: mild knee pain symptoms at the time of surgery (ARD 18.2% (95% Confidence Interval 13.6, 22.8), smoking 12.0% (95% CI:7.3, 16.6), living in the most deprived areas 5.6% (95% CI:2.3, 9.0) and obesity class II 6.3% (95% CI:3.0, 9.7). Important risk factors with more moderate effects included a history of previous knee arthroscopy surgery 4.6% (95% CI:2.5, 6.6), and use of opioids 3.4% (95% CI:1.4, 5.3) within three months after surgery. Those patients with worsening pain state change had more complications by 3 months (11.8% among those in a worse pain state vs. 2.7% with the same pain state). Conclusions We quantified the relative importance of individual risk factors including mild pre-operative pain, smoking, deprivation, obesity and opioid use in terms of the absolute proportions of patients achieving poor pain outcomes. These findings will support development of interventions to reduce the numbers of patients who have poor pain outcomes.

Original language	English
Article number	e0261850
Journal	PLoS ONE
Volume	16
Issue number	12 December
DOIs	https://doi.org/10.1371/journal.pone.0261850
Publication status	Published - 31 Dec 2021

Bibliographical note

Funding Information:
This study is funded by the National Institute for Health Research (NIHR) [Programme Grant for Applied Research (Grant Reference Number RP-PG-0613-20001)]. This study was also supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (Grant Reference number: IS-BRC-1215-20011). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Disclaimer The views expressed represent those of the authors and do not necessarily reflect those of the NHS, the National Institute for Health Research, the Programme Grants for Applied Research (PGfAR) Programme, the Department of Health and Social Care or the Healthcare Quality Improvement Partnership (HQIP) who do not vouch for how the information is presented.

ASJC Scopus subject areas

General

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1371/journal.pone.0261850Licence: CC BY

Fingerprint

Dive into the research topics of 'Risk factors associated with poor pain outcomes following primary knee replacement surgery: Analysis of data from the clinical practice research datalink, hospital episode statistics and patient reported outcomes as part of the STAR research programme'. Together they form a unique fingerprint.

Cite this

Mohammad, H. R., Gooberman-Hill, R., Delmestri, A., Broomfield, J., Patel, R., Huber, J., Garriga, C., Eccleston, C., Pinedo-Villanueva, R., Malak, T. T., Arden, N., Price, A., Wylde, V., Peters, T. J., Blom, A. W., & Judge, A. (2021). Risk factors associated with poor pain outcomes following primary knee replacement surgery: Analysis of data from the clinical practice research datalink, hospital episode statistics and patient reported outcomes as part of the STAR research programme. PLoS ONE, 16(12 December), Article e0261850. https://doi.org/10.1371/journal.pone.0261850

Risk factors associated with poor pain outcomes following primary knee replacement surgery: Analysis of data from the clinical practice research datalink, hospital episode statistics and patient reported outcomes as part of the STAR research programme. / Mohammad, Hasan Raza; Gooberman-Hill, Rachael; Delmestri, Antonella et al.
In: PLoS ONE, Vol. 16, No. 12 December, e0261850, 31.12.2021.

Research output: Contribution to journal › Article › peer-review

Mohammad, HR, Gooberman-Hill, R, Delmestri, A, Broomfield, J, Patel, R, Huber, J, Garriga, C, Eccleston, C, Pinedo-Villanueva, R, Malak, TT, Arden, N, Price, A, Wylde, V, Peters, TJ, Blom, AW & Judge, A 2021, 'Risk factors associated with poor pain outcomes following primary knee replacement surgery: Analysis of data from the clinical practice research datalink, hospital episode statistics and patient reported outcomes as part of the STAR research programme', PLoS ONE, vol. 16, no. 12 December, e0261850. https://doi.org/10.1371/journal.pone.0261850

Mohammad HR, Gooberman-Hill R, Delmestri A, Broomfield J, Patel R, Huber J et al. Risk factors associated with poor pain outcomes following primary knee replacement surgery: Analysis of data from the clinical practice research datalink, hospital episode statistics and patient reported outcomes as part of the STAR research programme. PLoS ONE. 2021 Dec 31;16(12 December):e0261850. doi: 10.1371/journal.pone.0261850

Mohammad, Hasan Raza ; Gooberman-Hill, Rachael ; Delmestri, Antonella et al. / Risk factors associated with poor pain outcomes following primary knee replacement surgery : Analysis of data from the clinical practice research datalink, hospital episode statistics and patient reported outcomes as part of the STAR research programme. In: PLoS ONE. 2021 ; Vol. 16, No. 12 December.

@article{1594e159ac994b049cce8a1a99ef2a44,

title = "Risk factors associated with poor pain outcomes following primary knee replacement surgery: Analysis of data from the clinical practice research datalink, hospital episode statistics and patient reported outcomes as part of the STAR research programme",

abstract = "Objective Identify risk factors for poor pain outcomes six months after primary knee replacement surgery. Methods Observational cohort study on patients receiving primary knee replacement from the UK Clinical Practice Research Datalink, Hospital Episode Statistics and Patient Reported Outcomes. A wide range of variables routinely collected in primary and secondary care were identified as potential predictors of worsening or only minor improvement in pain, based on the Oxford Knee Score pain subscale. Results are presented as relative risk ratios and adjusted risk differences (ARD) by fitting a generalized linear model with a binomial error structure and log link function. Results Information was available for 4,750 patients from 2009 to 2016, with a mean age of 69, of whom 56.1% were female. 10.4% of patients had poor pain outcomes. The strongest effects were seen for pre-operative factors: mild knee pain symptoms at the time of surgery (ARD 18.2% (95% Confidence Interval 13.6, 22.8), smoking 12.0% (95% CI:7.3, 16.6), living in the most deprived areas 5.6% (95% CI:2.3, 9.0) and obesity class II 6.3% (95% CI:3.0, 9.7). Important risk factors with more moderate effects included a history of previous knee arthroscopy surgery 4.6% (95% CI:2.5, 6.6), and use of opioids 3.4% (95% CI:1.4, 5.3) within three months after surgery. Those patients with worsening pain state change had more complications by 3 months (11.8% among those in a worse pain state vs. 2.7% with the same pain state). Conclusions We quantified the relative importance of individual risk factors including mild pre-operative pain, smoking, deprivation, obesity and opioid use in terms of the absolute proportions of patients achieving poor pain outcomes. These findings will support development of interventions to reduce the numbers of patients who have poor pain outcomes.",

author = "Mohammad, {Hasan Raza} and Rachael Gooberman-Hill and Antonella Delmestri and John Broomfield and Rita Patel and Joerg Huber and Cesar Garriga and Christopher Eccleston and Rafael Pinedo-Villanueva and Malak, {Tamer T.} and Nigel Arden and Andrew Price and Vikki Wylde and Peters, {Tim J.} and Blom, {Ashley W.} and Andrew Judge",

note = "Funding Information: This study is funded by the National Institute for Health Research (NIHR) [Programme Grant for Applied Research (Grant Reference Number RP-PG-0613-20001)]. This study was also supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (Grant Reference number: IS-BRC-1215-20011). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Disclaimer The views expressed represent those of the authors and do not necessarily reflect those of the NHS, the National Institute for Health Research, the Programme Grants for Applied Research (PGfAR) Programme, the Department of Health and Social Care or the Healthcare Quality Improvement Partnership (HQIP) who do not vouch for how the information is presented. ",

year = "2021",

month = dec,

day = "31",

doi = "10.1371/journal.pone.0261850",

language = "English",

volume = "16",

journal = "PLoS ONE",

issn = "1932-6203",

publisher = "Public Library of Science (PLOS)",

number = "12 December",

}

TY - JOUR

T1 - Risk factors associated with poor pain outcomes following primary knee replacement surgery

T2 - Analysis of data from the clinical practice research datalink, hospital episode statistics and patient reported outcomes as part of the STAR research programme

AU - Mohammad, Hasan Raza

AU - Gooberman-Hill, Rachael

AU - Delmestri, Antonella

AU - Broomfield, John

AU - Patel, Rita

AU - Huber, Joerg

AU - Garriga, Cesar

AU - Eccleston, Christopher

AU - Pinedo-Villanueva, Rafael

AU - Malak, Tamer T.

AU - Arden, Nigel

AU - Price, Andrew

AU - Wylde, Vikki

AU - Peters, Tim J.

AU - Blom, Ashley W.

AU - Judge, Andrew

N1 - Funding Information: This study is funded by the National Institute for Health Research (NIHR) [Programme Grant for Applied Research (Grant Reference Number RP-PG-0613-20001)]. This study was also supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (Grant Reference number: IS-BRC-1215-20011). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Disclaimer The views expressed represent those of the authors and do not necessarily reflect those of the NHS, the National Institute for Health Research, the Programme Grants for Applied Research (PGfAR) Programme, the Department of Health and Social Care or the Healthcare Quality Improvement Partnership (HQIP) who do not vouch for how the information is presented.

PY - 2021/12/31

Y1 - 2021/12/31

N2 - Objective Identify risk factors for poor pain outcomes six months after primary knee replacement surgery. Methods Observational cohort study on patients receiving primary knee replacement from the UK Clinical Practice Research Datalink, Hospital Episode Statistics and Patient Reported Outcomes. A wide range of variables routinely collected in primary and secondary care were identified as potential predictors of worsening or only minor improvement in pain, based on the Oxford Knee Score pain subscale. Results are presented as relative risk ratios and adjusted risk differences (ARD) by fitting a generalized linear model with a binomial error structure and log link function. Results Information was available for 4,750 patients from 2009 to 2016, with a mean age of 69, of whom 56.1% were female. 10.4% of patients had poor pain outcomes. The strongest effects were seen for pre-operative factors: mild knee pain symptoms at the time of surgery (ARD 18.2% (95% Confidence Interval 13.6, 22.8), smoking 12.0% (95% CI:7.3, 16.6), living in the most deprived areas 5.6% (95% CI:2.3, 9.0) and obesity class II 6.3% (95% CI:3.0, 9.7). Important risk factors with more moderate effects included a history of previous knee arthroscopy surgery 4.6% (95% CI:2.5, 6.6), and use of opioids 3.4% (95% CI:1.4, 5.3) within three months after surgery. Those patients with worsening pain state change had more complications by 3 months (11.8% among those in a worse pain state vs. 2.7% with the same pain state). Conclusions We quantified the relative importance of individual risk factors including mild pre-operative pain, smoking, deprivation, obesity and opioid use in terms of the absolute proportions of patients achieving poor pain outcomes. These findings will support development of interventions to reduce the numbers of patients who have poor pain outcomes.

AB - Objective Identify risk factors for poor pain outcomes six months after primary knee replacement surgery. Methods Observational cohort study on patients receiving primary knee replacement from the UK Clinical Practice Research Datalink, Hospital Episode Statistics and Patient Reported Outcomes. A wide range of variables routinely collected in primary and secondary care were identified as potential predictors of worsening or only minor improvement in pain, based on the Oxford Knee Score pain subscale. Results are presented as relative risk ratios and adjusted risk differences (ARD) by fitting a generalized linear model with a binomial error structure and log link function. Results Information was available for 4,750 patients from 2009 to 2016, with a mean age of 69, of whom 56.1% were female. 10.4% of patients had poor pain outcomes. The strongest effects were seen for pre-operative factors: mild knee pain symptoms at the time of surgery (ARD 18.2% (95% Confidence Interval 13.6, 22.8), smoking 12.0% (95% CI:7.3, 16.6), living in the most deprived areas 5.6% (95% CI:2.3, 9.0) and obesity class II 6.3% (95% CI:3.0, 9.7). Important risk factors with more moderate effects included a history of previous knee arthroscopy surgery 4.6% (95% CI:2.5, 6.6), and use of opioids 3.4% (95% CI:1.4, 5.3) within three months after surgery. Those patients with worsening pain state change had more complications by 3 months (11.8% among those in a worse pain state vs. 2.7% with the same pain state). Conclusions We quantified the relative importance of individual risk factors including mild pre-operative pain, smoking, deprivation, obesity and opioid use in terms of the absolute proportions of patients achieving poor pain outcomes. These findings will support development of interventions to reduce the numbers of patients who have poor pain outcomes.

UR - http://www.scopus.com/inward/record.url?scp=85122020260&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0261850

DO - 10.1371/journal.pone.0261850

M3 - Article

AN - SCOPUS:85122020260

SN - 1932-6203

VL - 16

JO - PLoS ONE

JF - PLoS ONE

IS - 12 December

M1 - e0261850

ER -

Risk factors associated with poor pain outcomes following primary knee replacement surgery: Analysis of data from the clinical practice research datalink, hospital episode statistics and patient reported outcomes as part of the STAR research programme

Abstract

Bibliographical note

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this