BACKGROUND Total hip replacement surgery is performed to improve quality of life (QoL). We explored the association between multimorbidity and change in QoL after total hip replacement. METHODS Analysis of patients included in the NHS England hip replacement Patient Reported Outcome Measures (PROMs) database with complete preoperative from 3 to 6 months postoperative EQ-5D QoL data from April 2013 to March 2018. Multimorbidity was defined as two or more chronic diseases excluding arthritis. The primary outcome measure was change in QoL using the Pareto Classification of Health Change. We compared QoL change for patients with and without multimorbidity and those with no multimorbidity using multivariable modelling. Data are presented as odds ratio (OR) with 95% confidence interval or n (%). RESULTS Of 216,191 patients, we included 178,129 (82.4%) patients with complete data. Most patients 63,327 (35.6%) were 70-79 yr of age, and 98,513 (55.3%) were women. Multimorbidity was present in 38,384 patients (21.6%). QoL improved after surgery for 149,774 (84.1%) patients, remained unchanged for 10,219 (5.7%) patients, and became worse after surgery for 7289 (4.1%) patients. QoL changes were mixed (at least one QoL domain improved and at least one deteriorated) for 10,847 (6.1%) patients. Poor QoL outcomes (unchanged/mixed/worse) were more likely for patients with multimorbidity (OR 1.53 [1.49-1.58]). CONCLUSIONS Hip replacement surgery improves QoL. However, patients with multimorbidity are less likely to experience these benefits. Poor QoL outcomes became more frequent as the number of comorbid diseases increased. These data should inform shared decision-making conversations around joint replacement surgery.

中文翻译：

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髋关节置换手术后多病共存与生活质量之间的关联：常规收集的患者报告结果分析。


背景 进行全髋关节置换手术以改善生活质量 （QoL）。我们探讨了共病与全髋关节置换术后 QoL 变化之间的关联。方法 分析包含在 NHS 英格兰髋关节置换术患者报告结果测量 （PROM） 数据库中的患者，以及 2013 年 4 月至 2018 年 3 月术后 3 至 6 个月的完整术前 EQ-5D QoL 数据。共存定义为两种或两种以上的慢性疾病，不包括关节炎。主要结局指标是使用 Pareto 健康变化分类的 QoL 变化。我们使用多变量模型比较了有和没有共病的患者和无共病患者的 QoL 变化。数据以比值比 （OR） 和 95% 置信区间或 n （%） 表示。结果 在 216,191 例患者中，我们纳入了 178,129 例 （82.4%） 具有完整数据的患者。大多数患者 63,327 名 （35.6%） 年龄在 70-79 岁之间，98,513 名 （55.3%） 是女性。38,384 例患者 （21.6%） 存在多病共存。149,774 例 （84.1%） 患者术后 QoL 改善，10,219 例 （5.7%） 患者保持不变，7289 例 （4.1%） 患者术后恶化。10,847 例 （6.1%） 患者的 QoL 变化喜忧参半 （至少一个 QoL 结构域改善，至少一个恶化）。多病共存患者 QoL 结局不良 （未改变/混合/更差） 的可能性更大 （OR 1.53 [1.49-1.58]）。结论 髋关节置换手术改善 QoL。然而，共存患者不太可能体验到这些好处。随着合并症数量的增加，不良的 QoL 结果变得更加频繁。这些数据应为围绕关节置换手术的共同决策对话提供信息。