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 R Mohammad; Rachael J S Gooberman-Hill; Antonella Delmestri; John Broomfield; Rita Patel; Joerg Huber; Cesar Garriga; Christopher Eccleston; Rafael Pinedo-Villanueva; T.T. Malak; Nigel K Arden; Andrew Price; Vikki Wylde; TJ 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 R Mohammad
, Rachael J S Gooberman-Hill
, Antonella Delmestri
, John Broomfield
, Rita Patel
, Joerg Huber
, Cesar Garriga
, Christopher Eccleston
, Rafael Pinedo-Villanueva
, T.T. Malak
, Nigel K Arden
, Andrew Price
, Vikki Wylde
, TJ Peters
, Ashley W Blom
, Andrew Judge^*

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

13 Citations (Scopus)

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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
Number of pages	16
Journal	PLOS ONE
Volume	16
Issue number	12
Early online date	31 Dec 2021
DOIs	https://doi.org/10.1371/journal.pone.0261850
Publication status	E-pub ahead of print - 31 Dec 2021

UN SDGs

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

SDG 3 Good Health and Well-being

Keywords

Knee replacement
Osteoarthritis
Epidemiology
Patient outcomes
Pain

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13 Citations
1 Article (Academic Journal)

Experiences of recovery and a new care pathway for people with pain after total knee replacement: qualitative research embedded in the STAR trial
Moore, A. J., Wylde, V., Bruce, J., Howells, N. R., Bertram, W. A., Eccleston, C. & Gooberman-Hill, R., 13 May 2022, In: BMC Musculoskeletal Disorders. 23, 1, 11 p., 451.
Research output: Contribution to journal › Article (Academic Journal) › peer-review

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11 Citations (Scopus)

110 Downloads (Pure)

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Mohammad, H. R., Gooberman-Hill, R. J. S., Delmestri, A., Broomfield, J., Patel, R., Huber, J., Garriga, C., Eccleston, C., Pinedo-Villanueva, R., Malak, T. T., Arden, N. K., Price, A., Wylde, V., Peters, TJ., 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), Article e0261850. Advance online publication. https://doi.org/10.1371/journal.pone.0261850

Mohammad, Hasan R ; Gooberman-Hill, Rachael J S ; 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.

@article{3a2d260092514485bf8b0ba96f324e4b,

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.",

keywords = "Knee replacement, Osteoarthritis, Epidemiology, Patient outcomes, Pain",

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

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Mohammad, HR, Gooberman-Hill, RJS, Delmestri, A, Broomfield, J, Patel, R, Huber, J, Garriga, C, Eccleston, C, Pinedo-Villanueva, R, Malak, TT, Arden, NK, 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, 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 R; Gooberman-Hill, Rachael J S; Delmestri, Antonella et al.
In: PLOS ONE, Vol. 16, No. 12, e0261850, 31.12.2021.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - 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

AU - Mohammad, Hasan R

AU - Gooberman-Hill, Rachael J S

AU - Delmestri, Antonella

AU - Broomfield, John

AU - Patel, Rita

AU - Huber, Joerg

AU - Garriga, Cesar

AU - Eccleston, Christopher

AU - Pinedo-Villanueva, Rafael

AU - Malak, T.T.

AU - Arden, Nigel K

AU - Price, Andrew

AU - Wylde, Vikki

AU - Peters, TJ

AU - Blom, Ashley W

AU - Judge, Andrew

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.

KW - Knee replacement

KW - Osteoarthritis

KW - Epidemiology

KW - Patient outcomes

KW - Pain

U2 - 10.1371/journal.pone.0261850

DO - 10.1371/journal.pone.0261850

M3 - Article (Academic Journal)

C2 - 34972159

SN - 1932-6203

VL - 16

JO - PLOS ONE

JF - PLOS ONE

IS - 12

M1 - e0261850

ER -

Mohammad HR, Gooberman-Hill RJS, 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):e0261850. Epub 2021 Dec 31. 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

Abstract

UN SDGs

Keywords

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Research output

Experiences of recovery and a new care pathway for people with pain after total knee replacement: qualitative research embedded in the STAR trial

Cite this