Accuracy of self-reported diagnosis of hip replacement

Deep Learning-Based Postoperative Recovery and Nursing of Total Hip Arthroplasty

Objective

To develop a deep learning-assisted recovery and nursing system after total hip arthroplasty and to conduct clinical trials in order to verify its accuracy.

Methods

In our study, based on manual labeling, the human hip X-ray image library was established, and the deep neural network based on Mask R-CNN was built. The labeled medical images were used to train the model, providing reference for nursing decision after hip replacement. A total of 80 patients with hip injury from 2016 to 2019 were selected for the study. In our paper, the patients were divided into experimental group and control group. The pertinence and effectiveness of the model for postoperative care were evaluated by comparing the hip pain (VAS index), recovery (Harris score), self-care ability (Barthel index), and postoperative complication rate between the two groups.

Results

The pain and complications in the experimental group were significantly lower than those in the control group, the difference being statistically significant (P < 0.05); the recovery of hip joint and self-care ability were higher than those in the control group, the difference being statistically significant (P < 0.05); the other differences were not statistically significant (P > 0.05).

Conclusion

The application of deep learning method in the rapid nursing after total hip replacement can significantly improve the nursing ability. Compared with the traditional method, it has stronger pertinence, faster postoperative recovery, lower incidence of complications, and greatly improves the postoperative quality of life of patients with hip injury.

Prevalence of Implanted Medical Devices in Medicine Inpatients

Implanted medical devices (IMDs) are extremely common, yet they are not systematically documented on hospital admission. Through structured patient interviews, we determined the prevalence of IMDs in hospital inpatients. Using medical record review, we evaluated the sensitivity of the medical record reporting of IMDs on an academic medical inpatient service. Fifty-eight percent of 191 interviewees reported 1 or more IMDs. Participants who reported greater than 1 IMD were older and had more frequent hospitalizations. The most common devices reported were surgical mesh, screws, plates, or wires (n = 47); intravascular stents (n = 25); and prosthetic joint replacements (n = 17). Forty-six patients (24%) reported greater than 1 IMD that had not been recorded in their admission history and physical examination. The prevalence of IMDs in hospitalized patients is high and underestimated in the medical record and may have significant implications for patient care.

Reliability of patient-reported complications following hip or knee arthroplasty procedures

BACKGROUND

Patient reported outcomes are increasingly used to assess the success of surgical procedures. Patient reported complications are often included as an outcome. However, these data must be validated to be accurate and useful in clinical practice.

METHODS

This was a retrospective descriptive study of 364 patients who had completed their six-month follow-up review questionnaire in the Arthroplasty Clinical Outcomes Registry, National (ACORN), an Australian orthopaedic registry. Patient-reported complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA) were compared to surgeon-reported complications recorded in their electronic medical records at their various follow-up appointments. Sensitivity, specificity, positive predictive value and negative predictive value were calculated. Agreement was assessed using percentage agreement and Cohen's kappa.

RESULTS

Patient-reported data from the ACORN registry returned overall low sensitivity (0.14), negative predictive value (0.13) and kappa values (0.11), but very high specificity (0.98), positive predictive value (0.98) and agreement values (96.3%) for reporting of complications when compared to surgeon-reported data. Values varied depending on the type and category of complication.

CONCLUSION

Patients are accurate in reporting the absence of complications, but not the presence. Sensitivity of patient-reported complications needs to be improved. Greater attention to the clarity of the questions asked may help in this respect.

Cross-Validation of Arthroplasty Records Between Arthroplasty and Hospital Discharge Registers, Self-Reports, and Medical Records Among a Cohort of 14,220 Women

BACKGROUND

There are no actual validation studies of the Finnish Arthroplasty Register (FAR), and only a few studies about the accuracy of self-reported hip and knee arthroplasty exist. Therefore, we examine how reliably total hip (THA) and knee (TKA) arthroplasties can be identified from multiple data sources, including self-reports, the hospital discharge register, the arthroplasty register, and medical records.

METHODS

Data from the FAR and from the Finnish Hospital Discharge Register (FHDR) during the years 1980-2010 were cross-checked to identify all THA and TKA events for the Kuopio Osteoporosis Risk Factor and Prevention Study cohort (n = 14,220). Unclear events were further checked from the medical records. After establishing a gold standard, by referring to confirmed THAs and TKAs, we examined the validity of self-reports in identifying the prevalent population with THA/TKA and in identifying incident THA/TKA.

RESULTS

Completeness of 2820 total arthroplasty events was 96.1% in FAR and 98.3% in FHDR. The self-reports had 95.1% sensitivity and 92.9% positive predictive value (PPV) to identify population with THA and for TKA sensitivity was 94.6% and PPV 95.2%. Self-reports' sensitivity of finding the actual surgery events was 65.3% and PPV 85.4% for THA and for TKA sensitivity was 62.9% and PPV 83.4%.

CONCLUSION

The best way to identify THAs and TKAs in Finland is to combine data from the FAR and the FHDR. Self-reports can be considered as suitable to identify the prevalent population with THA/TKA, and they do not work as well to identify the actual surgery events.

Accuracy of Internet-Based Patient Self-Report of Postdischarge Health Care Utilization and Complications Following Orthopedic Procedures: Observational Cohort Study

Background

The accuracy of patient self-report of health care utilization and complications has yet to be determined. If patients are accurate and engaged self-reporters, collecting this information in a manner that is temporally proximate to the health care utilization events themselves may prove valuable to health care organizations undertaking quality improvement initiatives for which such data are often unavailable.

Objective

The objective of this study was to measure the accuracy of patient self-report of health care utilization and complications in the 90 days following orthopedic procedures using an automated digital patient engagement platform.

Methods

We conducted a multicenter real-world observational cohort study across 10 orthopedic practices in California and Nevada. A total of 371 Anthem members with claims data meeting inclusion criteria who had undergone orthopedic procedures between March 1, 2015, and July 1, 2016, at participating practices already routinely using an automated digital patient engagement platform for asynchronous remote guidance and telemonitoring were sent surveys through the platform (in addition to the other materials being provided to them through the platform) regarding 90-day postencounter health care utilization and complications. Their self-reports to structured survey questions of health care utilization and complications were compared to claims data as a reference.

Results

The mean age of the 371 survey recipients was 56.5 (SD 15.7) years, 48.8% (181/371) of whom were female; 285 individuals who responded to 1 or more survey questions had a mean age of 56.9 (SD 15.4) years and a 49.5% (141/285) female distribution. There were no significant differences in demographics or event prevalence rates between responders and nonresponders. With an overall survey completion rate of 76.8% (285/371), patients were found to have accuracy of self-report characterized by a kappa of 0.80 and agreement of 0.99 and a kappa of 1.00 and agreement of 1.00 for 90-day hospital admissions and pulmonary embolism, respectively. Accuracy of self-report of 90-day emergency room/urgent care visits and of surgical site infection were characterized by a kappa of 0.45 and agreement of 0.96 and a kappa of 0.53 and agreement of 0.97, respectively. Accuracy for other complications such as deep vein thrombosis, hemorrhage, severe constipation, and fracture/dislocation was lower, influenced by low event prevalence rates within our sample.

Conclusions

In this multicenter observational cohort study using an automated internet-based digital patient engagement platform, we found that patients were most accurate self-reporters of 90-day hospital admissions and pulmonary embolism, followed by 90-day surgical site infection and emergency room/urgent care visits. They were less accurate for deep vein thrombosis and least accurate for hemorrhage, severe constipation, and fracture/dislocation. A total of 76.8% (285/371) of patients completed surveys without the need for clinical staff to collect responses, suggesting the acceptability to patients of internet-based survey dissemination from and collection by clinical teams. While our methods enabled detection of events outside of index institutions, assessment of accuracy of self-report for presence and absence of events and nonresponse bias analysis, low event prevalence rates, particularly for several of the complications, limit the conclusions that may be drawn for some of the findings. Nevertheless, this investigation suggests the potential that engaging patients in self-report through such survey modalities may offer for the timely and accurate measurement of matters germane to health care organizations engaged in quality improvement efforts post discharge.

Recording Adverse Events Following Joint Arthroplasty: Financial Implications and Validation of an Adverse Event Assessment Form

BACKGROUND

In Ireland, funding of joint arthroplasty procedures has moved to a pay-by-results national tariff system. Typically, adverse clinical events are recorded via retrospective chart-abstraction methods by administrative staff. Missed or undocumented events not only affect the quality of patient care but also may unrealistically skew budgetary decisions that impact fiscal viability of the service. Accurate recording confers clinical benefits and financial transparency. The aim of this study was to compare a prospectively implemented adverse events form with the current national retrospective chart-abstraction method in terms of pay-by-results financial implications.

METHODS

An adverse events form adapted from a similar validated model was used to prospectively record complications in 51 patients undergoing total hip or knee arthroplasties. Results were compared with the same cohort using an existing data abstraction method. Both data sets were coded in accordance with current standards for case funding.

RESULTS

Overall, 114 events were recorded during the study through prospective charting of adverse events, compared with 15 events documented by customary method (a significant discrepancy). Wound drainage (15.8%) was the most common complication, followed by anemia (7.9%), lower respiratory tract infections (7.9%), and cardiac events (7%). A total of €61,956 ($67,778) in missed funding was calculated as a result.

CONCLUSION

This pilot study demonstrates the ability to improve capture of adverse events through use of a well-designed assessment form. Proper perioperative data handling is a critical aspect of financial subsidies, enabling optimal allocation of funds.

Bone mineral density and association of osteoarthritis with fracture risk

OBJECTIVE

High body mass index (BMI) is associated with increased risk of osteoarthritis (OA) and reduced risk of fragility fracture. However, the relationship between fragility fracture and OA remained unclear. This study sought to investigate the effect of bone mineral density (BMD) in the OA-fracture relationship.

METHODS

Data from 2412 women and 1452 men aged >45 years in the Dubbo Osteoporosis Epidemiology Study (DOES) were analyzed. Individuals have been followed for up to 22 years (median: 7.5 years; range: 0.1-22 years). Femoral neck BMD (FNBMD) and lumbar spine BMD (LSBMD) was measured by dual energy X-ray absorptiometry (DXA) (GE LUNAR, Madison, WI). The presence of OA was ascertained at baseline by self-reported diagnosis. The incidence of low-trauma fracture was ascertained from X-ray reports.

RESULTS

Overall, 29% of women and 26% of men had reported a diagnosis of OA. Fracture risk was significantly higher in women with OA than those without OA (Hazard ratio (HR) = 1.50; 95% confidence interval (CI), 1.28-1.76). However, the association was mainly observed in women with osteopenic BMD (HR = 1.74; 95% CI, 1.38-2.17) and normal-BMD (HR = 1.50; 95% CI, 1.06-2.13) and not in those with osteoporosis. Further analysis revealed that osteopenic women with OA had significant increase in risk of vertebral (HR = 1.85; 95% CI, 1.24-2.75) and limb fracture (HR = 2.49; 95% CI, 1.77-3.48), but not in hip fracture. In men, no comparable relationship was found before and after adjustment for covariates.

CONCLUSION

Women with OA have an increased risk of fragility fracture, and the risk was mainly observed in non-osteoporotic group.

Patient report improves posthospital discharge event capture in total joint replacement: a novel approach to capturing all posthospital event data

Introduction:

Current approaches to quantifying total posthospital complications and readmissions following surgical procedures are limited because the United States does not have a single health care payer. Patients seek posthospital care in varied locations, yet hospitals can only quantify those returning to the same facility. Seeking information directly from patients about health care utilization following hospital discharge holds promise to provide data that is missing for surgeons and health care systems.

Background:

Because total joint replacement (TJR) is the most common and costly elective surgical hospitalization, we examined the concordance between patients’ self-report of potential short-term complications and their readmissions and our review of medical records in the initial hospital and surrounding facilities.

Methods:

Patients undergoing primary total hip or knee replacement from July 1, 2011, through December 3, 2012, at a large site participating in a national cohort of TJR patients were identified. Patients completed a six-month postoperative survey regarding emergency department (ED), day surgery (DS), or inpatient care for possible medical or mechanical post-TJR complications. We reviewed inpatient and outpatient medical records from all regional facilities and examined the sensitivity, specificity, and positive- and negative predictive values for patient self-report and medical records.

Findings:

There were 413 patients who had 431 surgeries and completed the six-month questionnaire. Patients reported 40 medical encounters (9 percent) including ED, DS or inpatient care, of which 20 percent occurred at hospitals different from the initial surgery. Review of medical records revealed 9 additional medical encounters that patients had not mentioned including five hospitalizations following surgery and four ED visits. Overall patient self-report of ED, DS, and inpatient care for possible complications was both sensitive (82 percent) and specific (100 percent). The positive predictive value was 100 percent and negative predictive value 98 percent.

Discussion:

Patient self-report of posthospital events was accurate. Substantial numbers of patients required care at outlying hospitals (not where the TJR occurred).

Conclusion:

Methods that directly engage patients can augment current posthospital utilization surveillance to assure complete data.

Good agreement between self-report and centralized hospitalizations data for arthritis-related surgeries

OBJECTIVES

To examine the level of agreement between self-reported and hospital administration records of arthritis-related surgeries for two large samples of community-dwelling older women in Australia, born between 1921-1926 and 1946-1951.

STUDY DESIGN AND SETTING

Self-report survey data from the Australian Longitudinal Study on Women's Health was linked to inpatient hospital data from the New South Wales Admitted Patient Data Collection. Levels of agreement were compared using Cohen's kappa, sensitivity, specificity, and positive and negative predictive values. Reasons for false positives were examined.

RESULTS

This study found good agreement (kappa >0.70; sensitivity and specificity >0.80) between self-report and hospitalizations data for arthritis-related surgeries.

CONCLUSIONS

This study provides new evidence for good agreement between self-reported health survey data and administrative records of arthritis-related joint procedures, and supports the use of self-report surveys in epidemiological studies of joint procedures where administrative data are either not available or not readily accessible, or where more extensive contextual information is needed. The use of health survey data in conjunction with administrative data has an important role to play in public health planning and policy.

Posttraumatic stress disorder, depression, and health-related quality of life in patients with bipolar disorder: review and new data from a multi-site community clinic sample

BACKGROUND

Evidence suggests that patients with bipolar disorder have an elevated risk for comorbid posttraumatic stress disorder (PTSD) compared to those without a bipolar diagnosis. Although bipolar disorder is associated with decreased health-related quality of life (HRQOL), it is unclear whether comorbid PTSD interacts to affect HRQOL.

METHOD

Baseline data from a multi-site study of patients with bipolar disorder were analyzed. Patient surveys ascertained clinical and demographic information, including physical and mental HRQOL based on the SF-12, mood symptoms (PHQ-9, Internal State Scale), and self-reported co-occurring conditions including PTSD.

RESULTS

Overall (N=384), 44.9% of patients self-reported co-occurring PTSD. Patients with PTSD had lower physical and mental HRQOL scores compared to those without PTSD (mean (SD) for those with and without PTSD, respectively): Mental Component Scale score 30.51 (8.22) and 32.86 (8.35); Physical Component Scale score 35.56 (7.77) and 37.21 (7.20). After adjusting for demographic and clinical factors including mood symptoms, multiple linear regression analyses revealed that PTSD was no longer significantly associated with physical or mental HRQOL; however, depressive symptoms were independently associated with mental HRQOL (Beta -0.63, p<0.01).

CONCLUSION

Depressive symptoms may explain the association between PTSD and mental HRQOL. Clinicians working with these patients will want to emphasize treatment of depression as important towards improving HRQOL for this group.

Clinical validation of an Internet-based questionnaire for ascertaining hip and knee osteoarthritis

OBJECTIVE

To evaluate the measurement properties of an Internet-based self-administered questionnaire in ascertaining cases of hip and knee osteoarthritis (OA).

METHODS

Questionnaire data from 4269 Canadian subjects aged 45-85 were collected on hip and knee joint health including self-reported items on medically-diagnosed hip and knee OA and joint replacement. A sub-cohort of 100 subjects was recruited for clinical examination. The self-reported outcomes were evaluated using the American College of Rheumatology clinical classification criteria for hip and knee OA as the gold standard for clinical verification. Analysis was at the joint level (200 knees, 200 hips). Validity was examined using sensitivity, specificity, and predictive values; to account for correlated joints of the same subject, bootstrapping was performed to yield valid 95% confidence interval (CI's).

RESULTS

Self-reported measures for a medical diagnosis of knee OA had a positive predictive value of 86%, negative predictive value 91%, sensitivity 73% and specificity 96% for correctly identifying clinical knee OA. For hip OA, the values were 61%, 98%, 81% and 94% respectively.

CONCLUSION

Internet self-report of medically-diagnosed hip and knee OA in metro Vancouver residents correctly identified most cases and non-cases of clinical OA when compared with the ACR clinical classification criteria gold standard. In particular, specificity was very high, important in risk factor studies due to the profound effect of even small losses in specificity on the measure of association. The findings provide evidence that these questionnaire case definitions have utility for identifying hip and knee OA in community and population-based studies when the purpose is to link potential risk factors with knee and hip health.

The validity of self-report as a technique for measuring short-term complications after total hip arthroplasty in a joint replacement registry

This study evaluated concordance between self-reports and surgeon assessments of short-term complications. A total of 3976 primary total hip arthroplasty patients consented for an institutional registry (5/2007-12/2008); 3186 (80.1%) completed a 6-month survey; 137 (4.4%) reported deep venous thrombosis, pulmonary embolism, major bleeding, fracture, or dislocation. Patients reporting complications were called. Positive predictive values and 95% confidence intervals (95% CI) for patient self-report were measured, using surgeon assessment for comparison: pulmonary embolism, 88.9% (95% CI, 78.4%-99.4%); dislocation, 81.1% (95% CI, 75.9%-86.5%); fracture, 73.7% (95% CI, 63.8%-83.5%); deep venous thrombosis, 69.7% (95% CI, 61.9%-77.5%); major bleeding, 32.0% (95% CI, 19.4%-44.5%); any bleeding, 88.0% (95% CI, 75.3%-99.9%). Of 97 confirmed complications, 64.95% presented to outside institutions. Registry data on self-reported complications may overcome limitations of traditional methods, but data should be interpreted cautiously. Concordance was high for PE and dislocation but low for major bleeding.

Pro-resolution immunological networks: binding immunoglobulin protein and other resolution-associated molecular patterns

Appropriate regulation and subsequent resolution of acute inflammatory events is critical to the prevention of autoinflammatory diseases. Indeed, the chronic inflammation observed in diseases such as RA is at least partially consequent on the failure of endogenous immunoregulation. Current RA therapies (e.g. anti-TNF-α inhibitors and MTX) inhibit components of the inflammatory disease process without directly promoting the resolution of inflammation. We propose that the next generation of RA therapeutics will complement and augment endogenous immunoregulatory and pro-resolution immunological networks, thus promoting the definitive resolution of inflammation rather than temporary immunological control. Of particular interest with respect to this therapeutic approach is binding immunoglobulin protein [BiP; also known as glucose-regulated protein-78 (GRP78)], a member of the recently defined resolution-associated molecular pattern (RAMP) family of molecules. In this review, we consider the preclinical evidence from experiments in mouse and man that suggests BiP and other members of the RAMP family have the potential to herald a new generation of immunotherapeutics.

Short-term coagulation complications following total knee arthroplasty: a comparison of patient-reported and surgeon-verified complication rates

Data from 3278 patients from a prospective patient-centered total joint registry was used to investigate the rates of complications in the first 6 months following primary total knee arthroplasty. All patients reporting deep venous thrombosis (DVT), pulmonary embolism (PE), or major bleeding were identified through patient self-reporting. Complications were verified by a review of imaging records and direct communication with patients by a surgeon. Surgeon-verified rates of DVT, PE, and major bleeding were 1.52%, 0.49%, and 0.34%, respectively. When compared with the complication rates as reported by patients, concordance was 86.2% for DVT, 84.2% for PE, and 36.7% for major bleeding. More than half (54.5%) of the complications were diagnosed and treated at the original operative hospital, and 45.5% were diagnosed and treated at other institutions.