The Dutch Audit for Treatment of Obesity (DATO) provides individual and composite outcome measures, assessing the short-term postoperative outcome after bariatric surgery, enable the possibility to... Show moreThe Dutch Audit for Treatment of Obesity (DATO) provides individual and composite outcome measures, assessing the short-term postoperative outcome after bariatric surgery, enable the possibility to identify outliers. Most importantly, individual hospitals can identify differences in outcome, whereas these may remain hidden in daily practice. This between-hospital variation may initiate an improvement cycle. This will probably result in hospital and surgical quality improvements leading to improved outcomes in bariatric surgery. Show less
The aims of this thesis were:1. To investigate associations between radiographic OA severity, knee instability, pain and function prior to and after THA and/or TKA.2. To evaluate factors... Show moreThe aims of this thesis were:1. To investigate associations between radiographic OA severity, knee instability, pain and function prior to and after THA and/or TKA.2. To evaluate factors influencing physical activities in patients with end-stage hip or knee OA.3. To identify determinants of return to work after THA or TKA.The research in this thesis showed that the combination of preoperative radiographic OA severity and pain perception of the patient are important predictors for the expected postoperative pain/function outcome due to effect modification. Furthermore, the initial clinical recovery after arthroplasty surgery and preoperative scores can be used during the postoperative recovery period to identify patients at risk for an unfavourable one-year outcome. Besides, it showed that kneeinstability could be considered as an easy identifiable surrogate outcome for poor pain relief and poor function. Furthermore, pain and functional limitations were not associated with an objective technical measurement of physical activity in patients with end-stage hip or knee OA. Finally, we found that preoperative occupational information (more specifically preoperative absence from work) and work-related expectations are important predictors for return to work after THA or TKA. Show less
Total hip-and total knee arthroplasties (THA/TKA) are effective treatments for end-stage hip/knee osteoarthritis, leading to satisfactory improvement of pain/function in 80-90% of the patients... Show moreTotal hip-and total knee arthroplasties (THA/TKA) are effective treatments for end-stage hip/knee osteoarthritis, leading to satisfactory improvement of pain/function in 80-90% of the patients within 12-months after surgery. Overall, knowledge regarding clinical outcomes reflecting the process of recovery in patients undergoing THA/TKA over a prolonged period is scarce. First, this thesis addressed the successfull feasibility of collecting a comprehensive set of outcomes relevant for the process of recovery. Second, it was found that the decrease in pain/improvement in function after 1 -year in THA-patients, but not in TKA-patients, was positively associated with more preoperative radiographic severity of OA. Thirdly, most patients’ preoperative expectations of outcomes of THA/TKA regarding functioning were met, unfortunately more frequently not in TKA-patients. Finally, 90%/52% of THA/TKA-patients return after surgery after 12-weeks on average. However, despite high return-to-work rates, a considerable proportion of the patients who return-to-work, worked less hours than preoperatively. Concluding, although overall favourable outcomes were seen, this thesis identified a number of areas for improvement: better identification of subgroups with a likely perceived unsuccessful outcome or recovery process, if not preoperatively then early after surgery. Early identification and subsequent interventions may change the course of recovery of THA/TKA for such patients, leading to added value in this subgroup. Show less
