Abstract
Aim
Bone and joint infections are a serious complication of trauma, surgery and soft tissue infections. However, there are few data presenting patient reported outcome measures for osteomyelitis. A recently proposed method for classification of osteomyelitis, BACH, stratifies patients into ‘uncomplicated’ and ‘complex’, based on four key inter-disciplinary components: Bone involvement, Anti-microbial options, soft-tissue Coverage and Host status. We aim to correlate the classification severity with patient reported outcomes following osteomyelitis surgery.
Method
Seventy-one patients with long-bone osteomyelitis, confirmed using a validated composite protocol, were included. Patients received a single-stage procedure at a specialist bone infection unit. Euro-Qol EQ-5D-3L questionnaires and Visual Analogue Scores (VAS) (0–100) were collected prospectively at baseline, 14 days, 6 weeks, 4 months and 1 year post-operatively. The EQ-5D-3L index score, a composite measure of performance of daily activities, was calculated from the 5 domains of the EQ-5D-3L. BACH was applied retrospectively by two independent clinicians blinded to all patient outcomes.
Results
There was significant improvement in VAS (58.2 vs. 78.9, p<0.01) and EQ-5D-3L index (0.284 vs. 0.740, p<0.01) scores from baseline to 1 year. ‘Uncomplicated’ osteomyelitis was associated with significantly higher EQ-5D-3L and VAS at 1 year follow-up when compared to ‘complex’ osteomyelitis (EQ-5D-3L: 0.900 vs. 0.685, p<0.01; VAS: 87.1 vs. 73.6, p<0.05). Patients with cavitary bone involvement (BACH type B1) reported higher outcome scores at all time points when compared to segmental involvement (B2) or infection involving the joint (B3). Good antimicrobial options gave higher outcome scores compared to patients with multi-drug resistant isolates (A2). Patients who had received microvascular tissue transfer (C2) initially reported lower outcome measures but returned to a similar level to patients who had their wounds closed directly (C1) from 6 weeks. Patients with severe co-morbidity (H2) reported lower outcome scores at all time points compared to those who were fit or with well controlled disease (H1).
Conclusions
Complex cases of osteomyelitis as defined by BACH classification, had poorer patient reported outcomes compared to uncomplicated cases. This was despite being managed in a centre that specialises in bone and joint infection. This study demonstrates that BACH is helpful for assessing case complexity and prognosis in osteomyelitis.
