Patient reported outcomes for elective surgery

Patients choose to undergo elective surgery in the hope that their condition will improve. Patient reported outcome measures (PROMs) capture the effectiveness of surgery from a patient's perspective by asking them about their health before and after their surgery. Here we look at PROMs for elective hip and knee replacements, groin hernia and varicose vein operations.

How do people rate their health with the EQ-5D descriptive system?

First we look at the findings from the EQ-5D descriptive system where patients are asked about five areas concerning their general health (see data notes for more information). The most improvement following surgery can be seen for patients who undergo hip replacements (an average 87% between 2009/2010 and 2011/2012), followed by knee replacements (an average 78% between 2009/2010 and 2011/2012). For groin hernia and varicose vein operations only slightly more than 50% of patients reported an improvement yet the other 50% reported no change or deterioration. Following feedback from PROMs users, from 2012 there was a change in the methodology for hip and knee replacement operations which are now recorded to distinguish between primary or revision operations. Thus now it is possible to see that there tends to be less improvement following revision operations for both knee and hip replacement.

Source: 
Patient Reported Outcome Measures, Health & Social Care Information Centre

How do people rate their health with EQ-VAS?

A different way to look at health status is the EQ-VAS where patients were simply asked to rate their health on a visual analogue scale from worst to best (0 to 100) (see data notes for more information). It is interesting to note that using this measure, for all four conditions patients consistently report less improvement with the operations. However, the greatest benefit from surgery can again be seen for hip replacement primary (an average 62% in the first three years) , followed by knee replacement (an average 51% in the first three years) and then varicose veins (a five-year average of 41%) and groin hernia (a five-year average of 38%) operations. Again it can be seen that a primary hip or knee replacement is more beneficial than a revision.

Source: 
Patient Reported Outcome Measures, Health & Social Care Information Centre

How do people rate their health with condition specific questions?

When patients are asked to fill out condition specific questionnaires (Aberdeen Varicose Vein Questionnaire and the Oxford Hip Scores and Oxford Knee Scores questionnaire), results are much more positive. For varicose vein operations, the proportion of people reporting improvement almost doubled (five-year average 83%) when compared to EQ-VAS (five-year average 41%) and is also higher than for EQ-5D (five-year average 53%). The proportion of people reporting improvement after hip and knee replacements is also highest for this measure. Overall, if a person decides to go for a varicose vein, hip or knee replacement surgery, they are very likely to undergo surgery based on these condition specific questionnaire results but certainly less likely to decide for a varicose vein surgery based on the previous two measures.

Source: 
Patient Reported Outcome Measures, Health & Social Care Information Centre
About this data

5D descriptive system and the EQ-5D visual analogue scale (EQ-VAS). The EQ-5D descriptive system comprises the following five dimensions: i) Mobility ii) Self-care, eg washing and dressing iii) Usual activities, eg work, study, housework, family or leisure activities iv) Pain/discomfort v) Anxiety/depression. Each dimension has three levels: no problems, some problems, severe problems. The EQ-VAS consists of a simple scale, from 0 to 100, presented in a simple linear format. Respondents are asked to rate their health state by marking the scale at the relevant point, with zero being the worst and one hundred being the best state.

Aberdeen Varicose Vein Questionnaire (AVVQ) is a condition-specific questionnaire that measures health status for patients with varicose veins. The questionnaire, designed in 1993, consists of 13 questions relating to key aspects of the problem of varicose veins.

Oxford Hip Scores and Oxford Knee Scores (OHS and OKS) are joint-specific outcome measure tools designed to assess symptoms and function in patients undergoing joint replacement surgery. The scores comprise 12 multiple choice questions relating to the patient’s experience of pain, ease of joint movement and ease of undertaking normal domestic activities such as walking or climbing stairs.

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