Impact of preoperative elbow dysfunction on health-related quality of life: an EQ-5D analysis in patients awaiting surgery.

Abstract

Elbow dysfunction can impair daily activities and reduce health-related quality of life (HRQoL). This study used the EuroQol five dimensions instrument (EQ-5D) alongside functional scores and treatment priorities to assess HRQoL in patients awaiting elective elbow surgery. In this prospective study, patients scheduled for elbow surgery from December 2024 onward were enrolled and categorized as having osteoarthritis, stiffness, or instability. HRQoL was measured using the EQ-5D. Multivariable regression was performed with EQ-5D as the dependent variable and waiting time, age, sex, and diagnosis as predictors. Functional outcomes were assessed with the Mayo Elbow Performance Score (MEPS) and Quick Disabilities of the Arm, Shoulder and Hand (qDASH). Patients also indicated whether they prioritized pain relief or improved mobility. Overall, 102 patients were included. The mean waiting time was 204±115 days, and the overall EQ-5D index was 0.67±0.06. Patients with osteoarthritis had the lowest EQ-5D index (0.60±0.29), highest pain levels (2.32±0.48), and greatest depression scores (1.97±0.75). They also showed the lowest MEPS and highest qDASH, with MEPS significantly lower than in patients with instability (P=0.016). The multivariable regression suggested non-significant trends toward lower EQ-5D with longer waiting times (β=-0.0001, P=0.663) and older age (β=0.002, P=0.306). Osteoarthritis patients prioritized pain relief (P=0.026), and stiffness patients prioritized mobility (P=0.021). Although longer waiting times and older age showed non-significant trends toward lower HRQoL, osteoarthritis patients were most affected, with the lowest EQ-5D (0.60) and significantly worse MEPS (P=0.016) than in the other groups. Future studies should test whether preoperative pain or psychological support can mitigate HRQoL decline. Level of evidence: II.