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Chen W, Tay ML, Bolam S, Monk AP, Young SW. Accuracy and completeness of registry-reported unicompartmental knee arthroplasty revision. ANZ J Surg 2024; 94:1502-1506. [PMID: 38741460 DOI: 10.1111/ans.19035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION The key outcome of joint registries is revision events, which inform clinical practice and identify poor-performing implants. Registries record revision events and reasons, but accuracy may be limited by a lack of standardized definitions of revision. Our study aims to assess the accuracy and completeness of unicompartmental knee arthroplasty (UKA) revision and indications reported to the New Zealand Joint Registry (NZJR) with independent clinical review. METHODS Case record review of 2272 patients undergoing primary UKA at four large tertiary hospitals between 2000 and 2017 was performed, identifying 158 patients who underwent revision. Detailed review of clinical findings, radiographs and operative data was performed to identify revision cases and the reasons for revision using a standardized protocol. These were compared to NZJR data using chi-squared and Fisher exact tests. RESULTS The NZJR recorded 150 (95%) of all UKA revisions. Osteoarthritis progression was the most common reason on the systematic clinical review (35%), however, this was underreported to the registry (8%, P < 0.001). A larger proportion of revisions reported to the registry were for 'pain' (30% of cases vs. 5% on clinical review, P < 0.001). A reason for revision was not reported to the registry for 10% of cases. CONCLUSION The NZJR had good capture of UKA revisions, but had significant differences in registry-reported revision reasons compared to our independent systematic clinical review. These included over-reporting of 'pain', under-reporting of osteoarthritis progression, and failing to identify a revision reason. Efforts to improve registry capture of revision reasons for UKA could be addressed through more standardized definitions of revision and tailored revision options for UKA on registry forms.
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Affiliation(s)
- William Chen
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Mei Lin Tay
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Auckland, New Zealand
| | - Scott Bolam
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Auckland, New Zealand
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - A Paul Monk
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Simon W Young
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Auckland, New Zealand
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Prentice HA, Harris JE, Sucher K, Fasig BH, Navarro RA, Okike KM, Maletis GB, Guppy KH, Chang RW, Kelly MP, Hinman AD, Paxton EW. Improvements in Quality, Safety and Costs Associated with Use of Implant Registries Within a Health System. Jt Comm J Qual Patient Saf 2024; 50:404-415. [PMID: 38368191 DOI: 10.1016/j.jcjq.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Clinical quality registries (CQRs) are intended to enhance quality, safety, and cost reduction using real-world data for a self-improving health system. Starting in 2001, Kaiser Permanente established several medical device CQRs as a quality improvement initiative. This report examines the contributions of these CQRs on improvement in health outcomes, changes in clinical practice, and cost-effectiveness over the past 20 years. METHODS Eight implant registries were instituted with standardized collection from the electronic health record and other institutional data sources of patient characteristics, medical comorbidities, implant attributes, procedure details, surgical techniques, and outcomes (including complications, revisions, reoperations, hospital readmissions, and other utilization measures). A rigorous quality control system is in place to improve and maintain the quality of data. Data from the Implant Registries form the basis for multiple quality improvement and patient safety initiatives to minimize variation in care, promote clinical best practices, facilitate recalls, perform benchmarking, identify patients at risk, and construct reports about individual surgeons. RESULTS Following the inception of the Implant Registries, there was an observed (1) reduction in opioid utilization following orthopedic procedures, (2) reduction in use of bone morphogenic protein during lumbar fusion allowing for cost savings, (3) reduction in allograft for anterior cruciate ligament reconstruction and subsequent decrease in organizationwide revision rates, (4) cost savings through expansion of same-day discharge programs for joint arthroplasty, (5) increase in the use of cement fixation in the hemiarthroplasty treatment of hip fracture, and (6) organizationwide discontinuation of an endograft device associated with a higher risk for adverse outcomes following endovascular aortic aneurysm repair. CONCLUSION The use of Implant Registries within our health system, along with clinical leadership and organizational commitment to a learning health system, was associated with improved quality and safety outcomes and reduced costs. The exact mechanisms by which such registries affect health outcomes and costs require further study.
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Nugen F, Vera Garcia DV, Sohn S, Mickley JP, Wyles CC, Erickson BJ, Taunton MJ. Application of Natural Language Processing in Total Joint Arthroplasty: Opportunities and Challenges. J Arthroplasty 2023; 38:1948-1953. [PMID: 37619802 DOI: 10.1016/j.arth.2023.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
Total joint arthroplasty is becoming one of the most common surgeries within the United States, creating an abundance of analyzable data to improve patient experience and outcomes. Unfortunately, a large majority of this data is concealed in electronic health records only accessible by manual extraction, which takes extensive time and resources. Natural language processing (NLP), a field within artificial intelligence, may offer a viable alternative to manual extraction. Using NLP, a researcher can analyze written and spoken data and extract data in an organized manner suitable for future research and clinical use. This article will first discuss common subtasks involved in an NLP pipeline, including data preparation, modeling, analysis, and external validation, followed by examples of NLP projects. Challenges and limitations of NLP will be discussed, closing with future directions of NLP projects, including large language models.
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Affiliation(s)
- Fred Nugen
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Mayo Clinic, Rochester, Minnesota; Radiology Informatics Lab (RIL), Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Diana V Vera Garcia
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Mayo Clinic, Rochester, Minnesota; Radiology Informatics Lab (RIL), Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Sunghwan Sohn
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - John P Mickley
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Mayo Clinic, Rochester, Minnesota; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Cody C Wyles
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Mayo Clinic, Rochester, Minnesota; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Bradley J Erickson
- Radiology Informatics Lab (RIL), Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Michael J Taunton
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Mayo Clinic, Rochester, Minnesota; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Grammatico-Guillon L, Banaei-Bouchareb L, Solomiac A, Miliani K, Astagneau P, May-Michelangeli L. Validation of the first computerized indicator for orthopaedic surgical site infections in France: ISO-ORTHO. Antimicrob Resist Infect Control 2023; 12:44. [PMID: 37143157 PMCID: PMC10161661 DOI: 10.1186/s13756-023-01239-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 04/03/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The French national authority for health (HAS) develops in-hospital indicators for improving quality of care, safety and patient outcome. Since 2017, it has developed a measurement of surgical site infections (SSI) after total hip or knee arthroplasty (TH/KA) by using a computerized indicator, called ISO-ORTHO, based on a hospital discharge database (HDD) algorithm. The aim of the study was to assess the performance of this new indicator . METHODS The ISO-ORTHO performance was estimated via its positive predictive value (PPV) among adult patients having undergone a TH/KA between January 1st and September 30th 2018, based on the orthopaedic procedure codes. Patients at very high risk of SSI and/or with SSI not related to the in-hospital care were excluded. SSI were detected from the date of admission up to 90 days after the TH/KA using the ISO-ORTHO algorithm, based on 15 combinations of ICD-10 and procedure codes. Its PPV was estimated by a chart review in volunteer healthcare organisations (HCO). RESULTS Over the study period, 777 HCO including 143,227 TH/KA stays were selected, providing 1,279 SSI according to the ISO-ORTHO indicator. The 90-day SSI rate was 0.89 per 100 TH/KA stays (0.98% for THA and 0.80% for TKA). Among the 448 HCO with at least 1 SSI, 250 HCO participated in reviewing 725 SSI charts; 665 were confirmed, giving a PPV of 90.3% [88.2-92.5%], 89.9% [87.1-92.8%] in THA and 90.9% [87.7-94.2%] in TKA. CONCLUSIONS The PPV of ISO-ORTHO over 90% confirms its validity for any use according to the HAS method. ISO-ORTHO and detailed information were provided in 2020 to HCO and used for quality assessment and in-hospital risk management.
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Affiliation(s)
- Leslie Grammatico-Guillon
- Service of Public Health, Epidemiology and data center, Teaching hospital of Tours and Medical School of Tours, Tours, France.
- Medical School, University of tours, Tours, France.
- Center for Prevention of Healthcare Associated Infection, INSERM, Institute of Epidemiology and Public Health, Sorbonne University, Paris, F75013, France.
| | - Linda Banaei-Bouchareb
- French National Authority for Health ("Haute Autorité de Santé", HAS), Saint Denis, France
| | - Agnès Solomiac
- French National Authority for Health ("Haute Autorité de Santé", HAS), Saint Denis, France
| | - Katiuska Miliani
- Center for Prevention of Healthcare Associated Infection, INSERM, Institute of Epidemiology and Public Health, Sorbonne University, Paris, F75013, France
| | - Pascal Astagneau
- Center for Prevention of Healthcare Associated Infection, INSERM, Institute of Epidemiology and Public Health, Sorbonne University, Paris, F75013, France
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Habermann EB, Harris AHS, Giori NJ. Large Surgical Databases with Direct Data Abstraction: VASQIP and ACS-NSQIP. J Bone Joint Surg Am 2022; 104:9-14. [PMID: 36260037 DOI: 10.2106/jbjs.22.00596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Direct data abstraction from a patient's chart by experienced medical professional data abstractors has been the historical gold standard for quality and accuracy in clinical medical research. The limiting challenge to population-wide studies for quality and public health purposes is the high personnel costs associated with very large-scale efforts of this type. Two historically related programs that are at least partially able to successfully circumvent this problem and provide high-quality data relating to surgical procedures and the early postoperative period are reviewed in this article. Both utilize similar data abstraction efforts by specially trained and qualified medical abstractors of a sample subset of the total procedures performed at participating hospitals.The Veterans Affairs Surgical Quality Improvement Program (VASQIP), detailed by Nicholas J. Giori, MD, PhD, in the first section of this article, makes use of trained abstractors and has undergone recent additions and updates, including the development of an associated total hip registry for the VA system. The data elements and data integrity provided by both of these programs establish important benchmarks for other "big data" efforts, which often attempt to use alternative less-expensive methods of data collection in order to achieve more widespread or even nationwide data collection.In the second section, Elizabeth B. Habermann, PhD, MPH, provides a detailed review of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), the data elements collected, and examples of the range of quality improvement and outcomes studies in orthopaedic surgery that it has made possible, along with information on data that have not been collected and the resulting limitations. The ACS NSQIP was actually modeled after the very similar earlier effort started by the United States Department of Veterans Affairs (VA).
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Affiliation(s)
- Elizabeth B Habermann
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Alex H S Harris
- VA Palo Alto Health Care System, Palo Alto, California.,Department of Surgery, Stanford University, Stanford, California
| | - Nicholas J Giori
- VA Palo Alto Health Care System, Palo Alto, California.,Department of Orthopedic Surgery, Stanford University, Stanford, California
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Nuutinen M, Lyly A, Virkkula P, Hytönen M, Saarentaus E, Mäkitie A, Palotie A, Torkki P, Haukka J, Toppila‐Salmi S. The relative proportion of comorbidities among rhinitis and rhinosinusitis patients and their impact on visit burden. Clin Transl Allergy 2022; 12:e12181. [PMID: 35874969 PMCID: PMC9301683 DOI: 10.1002/clt2.12181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background The aim was to evaluate the relative proportion of Non-steroidal anti-inflammatory drug exacerbated respiratory disease (NERD) and other comorbidities, and their impact on the burden of outpatient visits due to allergic rhinitis (AR), non-allergic rhinitis (NAR), acute rhinosinusitis (ARS), and chronic rhinosinusitis with nasal polyps (CRSwNP) and without (CRSsNP). Methods We used hospital registry data of a random sample of 5080 rhinitis/rhinosinusitis patients diagnosed during 2005-2019. International Statistical Classification of Diseases and Related Health Problems (ICD10) diagnoses, visits, and other factors were collected from electronic health records by using information extraction and data processing methods. Cox's proportional hazards model was used for modeling the time to the next outpatient visit. Results The mean (±standard deviation) age of the population was 33.6 (±20.7) years and 56.1% were female. The relative proportion of AR, NAR, ARS, CRSsNP and CRSwNP, were 33.5%, 27.5%, 27.2%, 20.7%, and 10.9%, respectively. The most common other comorbidities were asthma (44.4%), other chronic respiratory diseases (38.5%), musculoskeletal diseases (38.4%), and cardiovascular diseases (35.7%). Non-steroidal anti-inflammatory drug exacerbated respiratory disease existed in 3.9% of all patients, and 17.7% of the CRSwNP group. The relative proportion of subjects having 1, 2, 3 and ≥ 4 other diseases were 18.0%, 17.6%, 17.0%, 37.0%, respectively. All diseases except AR, ARS, and mouth breathing, were associated with a high frequency of outpatient visits. Conclusions Our results revealed a high relative proportion of NERD and other comorbidities, which affect the burden of outpatient visits and hence confirm the socioeconomic impact of upper airway diseases.
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Affiliation(s)
| | - Annina Lyly
- Skin and Allergy HospitalUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
- Department of Otorhinolaryngology–Head and Neck SurgeryHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Paula Virkkula
- Department of Otorhinolaryngology–Head and Neck SurgeryHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Maija Hytönen
- Department of Otorhinolaryngology–Head and Neck SurgeryHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Elmo Saarentaus
- Department of Otorhinolaryngology–Head and Neck SurgeryHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Antti Mäkitie
- Department of Otorhinolaryngology–Head and Neck SurgeryHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Aarno Palotie
- HiLIFEInstitute for Molecular Medicine Finland (FIMM)University of HelsinkiHelsinkiFinland
- Analytic and Translational Genetics UnitMassachusetts General HospitalBostonMassachusettsUSA
- Program in Medical and Population GeneticsBroad Institute of Harvard and MITCambridgeMassachusettsUSA
- Stanley Center for Psychiatric ResearchBroad Institute of Harvard and MITCambridgeMassachusettsUSA
| | - Paulus Torkki
- Department of Public HealthUniversity of HelsinkiHelsinkiFinland
| | - Jari Haukka
- Department of Public HealthUniversity of HelsinkiHelsinkiFinland
| | - Sanna Toppila‐Salmi
- Haartman InstituteUniversity of HelsinkiHelsinkiFinland
- Skin and Allergy HospitalUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
- Department of Pulmonary MedicineHeart and Lung CenterHelsinki University Hospital and University of HelsinkiHelsinkiFinland
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Tyagi V, Harris AHS, Giori NJ. Survival of Hydroxyapatite-Coated Versus Non-hydroxyapatite-Coated Total Hip Arthroplasty Implants in a Veteran Population. J Arthroplasty 2022; 37:1143-1145. [PMID: 35219818 DOI: 10.1016/j.arth.2022.02.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Hydroxyapatite (HA) coatings were introduced to improve uncemented implant osteointegration and to prevent loosening and osteolysis. However, data regarding these implants have been inconsistent. We studied the effect of HA coating of femoral stems and acetabular cups on component revision after primary total hip arthroplasty (THA) in the veteran population. METHODS We identified patients who underwent uncemented primary THA at any Veterans Health Administration (VHA) hospital from 2000 to 2017 and who had implants that were available as either HA-coated or non-HA-coated models. The endpoint was removal of the component of interest for any reason. For each individual stem and shell, unadjusted and adjusted (for age and body mass index) Cox proportional hazards models were used to estimate hazard ratios for the risk of explantation between HA-coated and non-HA-coated implants of the same type. RESULTS A total of 262 HA-coated cups, 4580 non-HA-coated cups, 4767 HA-coated stems, and 9397 non-HA-coated stems were available for analysis. The mean follow-up time was 9.01 years (43,627 total implant-years) for cups and 7.13 years (101,004 total implant-years) for stems. One of the two shells reviewed had significantly lower survivorship and an elevated hazard ratio for explantation with HA coating. Among the five implant pairs of stems, and the other shell, implant survival and hazard ratios for explantation were not affected by HA coating. CONCLUSION HA coating did not improve THA implant survival in our veteran population. Although HA-coated versions of hip implants tend to be more costly than their noncoated counterparts, these results do not support their general use.
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Affiliation(s)
- Vineet Tyagi
- VA Palo Alto Health Care System, Palo Alto, California; Department of Orthopedic Surgery, Stanford University, Stanford, California
| | - Alex H S Harris
- VA Palo Alto Health Care System, Palo Alto, California; Department of Surgery, Stanford University, Stanford, California
| | - Nicholas J Giori
- VA Palo Alto Health Care System, Palo Alto, California; Department of Orthopedic Surgery, Stanford University, Stanford, California
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How Accurate Is ICD-10 Coding for Revision Total Knee Arthroplasty? J Arthroplasty 2021; 36:3950-3958. [PMID: 34538547 DOI: 10.1016/j.arth.2021.08.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/31/2021] [Accepted: 08/20/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The International Classification of Diseases-10 (ICD-10) came into effect in October 2015. The new procedural codes (ICD-10-PCS) were designed to specify granular aspects of the procedure, including laterality and revised components. This specificity could improve data collection in institutional databases, large registries, and administrative claims data. Given these possible applications, this study's purpose was to assess the accuracy of ICD-10-PCS coding for revision total knee arthroplasty (rTKA). METHODS This multicenter retrospective analysis utilized the rTKA databases at four academic medical centers for all aseptic rTKAs between October 1, 2015 and July 3, 2019. Operative reports were reviewed to determine laterality and revised components (tibial, femoral, liner, and patellar component), which were then compared with the ICD-10-PCS codes associated with the billing records. Proper coding required both component removal and replacement codes. The correct series of removal and replacement codes was determined using the American Joint Replacement Registry's guidelines. RESULTS In total, 1906 rTKAs were examined, and 98.0% had at least one proper ICD-10-PCS code, indicating an rTKA had occurred. Coding for components replaced was correct in 76.3% of cases. When examining both removal and replacement codes, accuracy dropped to 57.0%. CONCLUSION Nearly 25% of rTKA procedures were incorrectly coded for replaced components, and over 40% were incorrectly coded for removed and replaced components. ICD-10-PCS codes can accurately identify that an rTKA has occurred; however, the inaccuracy in identifying which specific components were revised should prompt further evaluation of the coding process before utilizing ICD-10-PCS codes to report granular rTKA data. LEVEL OF EVIDENCE III, retrospective observational analysis.
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