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Holland AM, Mead BS, Lorenz WR, Scarola GT, Augenstein VA. Racial and Socioeconomic Disparities in Complex Abdominal Wall Reconstruction Referrals. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2024; 3:12946. [PMID: 38873344 PMCID: PMC11169567 DOI: 10.3389/jaws.2024.12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/20/2024] [Indexed: 06/15/2024]
Abstract
Background: Health disparities are pervasive in surgical care. Particularly racial and socioeconomic inequalities have been demonstrated in emergency general surgery outcomes, but less so in elective abdominal wall reconstruction (AWR). The goal of this study was to evaluate the disparities in referrals to a tertiary hernia center. Methods: A prospectively maintained hernia database was queried for patients who underwent open ventral hernia (OVHR) or minimally invasive surgical (MISR) repair from 2011 to 2022 with complete insurance and address information. Patients were divided by home address into in-state (IS) and out-of-state (OOS) referrals as well as by operative technique. Demographic data and outcomes were compared. Standard and inferential statistical analyses were performed. Results: Of 554 patients, most were IS (59.0%); 334 underwent OVHR, and 220 underwent MISR. IS patients were more likely to undergo MISR (OVHR: 45.6% vs. 81.5%, laparoscopic: 38.2% vs. 14.1%, robotic: 16.2% vs. 4.4%; p < 0.001) when compared to OOS referrals. Of OVHR patients, 44.6% were IS and 55.4% were OOS. Patients' average age and BMI, sex, ASA score, and insurance payer were similar between IS and OOS groups. IS patients were more often Black (White: 77.9% vs. 93.5%, Black: 16.8% vs. 4.3%; p < 0.001). IS patients had more smokers (12.1% vs. 3.2%; p = 0.001), fewer recurrent hernias (45.0% vs. 69.7%; p < 0.001), and smaller defects (155.7 ± 142.2 vs. 256.4 ± 202.9 cm2; p < 0.001). Wound class, mesh type, and rate of fascial closure were similar, but IS patients underwent fewer panniculectomies (13.4% vs. 34.1%; p < 0.001), component separations (26.2% vs. 51.4%; p < 0.001), received smaller mesh (744.2 ± 495.6 vs. 975.7 ± 442.3 cm2; p < 0.001), and had shorter length-of-stay (4.8 ± 2.0 vs. 7.0 ± 5.5 days; p < 0.001). There was no difference in wound breakdown, seroma requiring intervention, hematoma, mesh infection, or recurrence; however, IS patients had decreased wound infections (2.0% vs. 8.6%; p = 0.009), overall wound complications (11.4% vs. 21.1%; p = 0.016), readmissions (2.7% vs. 13.0%; p = 0.001), and reoperations (3.4% vs. 11.4%; p = 0.007). Of MISR patients, 80.9% were IS and 19.1% were OOS. In contrast to OVHR, MISR IS and OOS patients had similar demographics, preoperative characteristics, intraoperative details, and postoperative outcomes. Conclusion: Although there were no differences in referred patients for MISR, this study demonstrates the racial disparities that exist among our IS and OOS complex, open AWR patients. Awareness of these disparities can help clinicians work towards equitable access to care and equal referrals to tertiary hernia centers.
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Affiliation(s)
| | | | | | | | - Vedra A. Augenstein
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, United States
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Pacheco-Brousseau L, Poitras S, Ben Amor S, Desmeules F, Kiss A, Stacey D. Hip and Knee Total Joint Arthroplasty Online Resources for Patients and Health Care Professionals: A Canadian Environmental Scan. Physiother Can 2023. [DOI: 10.3138/ptc-2022-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Purpose: To appraise the quality of publicly available online Canadian resources for patients with hip or knee osteoarthritis considering total joint arthroplasty (TJA) and health care professionals participating in TJA decision-making processes. Method: An environmental scan. Two independent authors appraised: a) patient resources against the International Patient Decision Aids Standards (IPDAS) criteria and the Patient Education Material Evaluation Tool (PEMAT); and b) health care professional resources against six appropriateness criteria for TJA and eight elements of shared decision-making. Analysis was descriptive. Results: Of 84 included resources, 71 were for patients, 11 for health care professionals, and 2 for both. For patient resources, the median number of IPDAS defining criteria met was 2 of 7, median PEMAT understandability score was 83%, and median PEMAT actionability score was 60%. For health care professional resources, the median number of appropriateness criteria was 3 of 6, and the median number of shared decision-making elements was 3 of 8. Conclusions: Only four of 73 patient resources were structured to help patients consider their options and reach a decision based on their preferences. Health care professional resources were limited to traditional criteria for determining TJA appropriateness (evidence of osteoarthritis, use of conservative treatments) and poorly met key elements of shared decision-making.
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Amen TB, Liimakka AP, Jain B, Rudisill SS, Bedair HS, Chen AF. Total Joint Arthroplasty Utilization After Orthopaedic Surgery Referral: Identifying Disparities Along the Care Pathway. J Arthroplasty 2023; 38:424-430. [PMID: 36150431 DOI: 10.1016/j.arth.2022.09.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although racial and ethnic disparities in total joint arthroplasty (TJA) have been thoroughly described, only a few studies have sought to determine exactly where along the care pathway these disparities are perpetuated. The purpose of this study was to investigate disparities in TJA utilization occurring after patients who had diagnosed hip or knee osteoarthritis were referred to a group of orthopaedic providers within an integrated academic institution. METHODS A retrospective, multi-institutional study evaluating patients with diagnosed hip or knee osteoarthritis was conducted between 2015 and 2019. Information pertaining to patient demographics, timing of clinic visits, and subsequent surgical intervention was collected. Utilization rates and time to surgery from the initial clinic visit were calculated by race, and logistic regressions were performed to control for various demographic as well as health related variables. RESULTS White patients diagnosed with knee osteoarthritis were significantly more likely to receive total knee arthroplasty (TKA) than Black and Hispanic patients, even after adjusting for various demographic variables (Black patients: odds ratio [OR] = 0.63, 95% CI = 0.55-0.72, P = .002; Hispanic patients: OR = 0.69, 95% CI = 0.57-0.83, P = .039). Similar disparities were found among patients diagnosed with hip osteoarthritis who underwent total hip arthroplasty (THA; Black patients: OR = 0.73, 95% CI = 0.60-0.89, P = <.001; Hispanic patients: OR = 0.72, 95% CI = 0.53-0.98, P <.001). There were no differences in time to surgery between races (P > .05 for all). CONCLUSION In this study, racial and ethnic disparities in TJA utilization were found to exist even after referral to an orthopaedic surgeon, highlighting a critical point along the care pathway during which inequalities in TJA care can emerge. Similar time to surgery between White, Black, and Hispanic patients suggest that these disparities in TJA utilization may largely be perpetuated before surgical planning while patients are deciding whether to undergo surgery. Further studies are needed to better elucidate which patient and provider-specific factors may be preventing these patients from pursuing surgery during this part of the care pathway. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Troy B Amen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Adriana P Liimakka
- Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Bhav Jain
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Samuel S Rudisill
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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4
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Surgery for Osteoarthritis. Clin Geriatr Med 2022; 38:385-396. [DOI: 10.1016/j.cger.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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5
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Zhang L, Fu W. A commentary on “The influence of prior arthroscopy on outcomes of primary total lower extremity arthroplasty: A systematic review and meta-analysis” (Int J Surg 2022; 98:106218). Int J Surg 2022; 101:106607. [DOI: 10.1016/j.ijsu.2022.106607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
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Xing XX, Zhu C, Chu YQ, Bai XR, Wang K, Zhang ST, Yan SY. Physicians' knowledge, attitude, and prescribing behavior regarding stress ulcer prophylaxis in China: a multi-center study. BMC Gastroenterol 2021; 21:402. [PMID: 34696716 PMCID: PMC8547063 DOI: 10.1186/s12876-021-01979-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 10/12/2021] [Indexed: 02/04/2023] Open
Abstract
Background Perioperative patients are at risk of developing stress ulcers (SU), which can cause clinically important bleeding. Stress ulcer prophylaxis (SUP) is widely applied to the patients in Intensive care unit (ICU) as well as the general ward, so it may lead to overmedication. However, there have been no surveys regarding SUP knowledge or prescribing habits.
Objective Our study assessed the knowledge, attitudes, and prescribing behavior of the surgeons toward perioperative patients regarding SUP and determined factors associated with low knowledge and high level of prescribing behaviors. Methods We performed a cross-sectional survey using questionnaires, randomly sampling 1266 surgeons on their current SUP practices. Results Proton pump inhibitors for SUP were used the most (94%); 43% used lansoprazole. Guideline awareness was inconsistent; the most familiar guideline was the National Medical Journal of China, and 46% were unaware of any guidelines. The predictors of low knowledge score regarding SUP in multivariable analysis were the hospital grade (p = 0.000), the type of hospital (p = 0.044), attendance at continuing education programs (p = 0.037), the awareness of clinical practice guidelines (CPGs) for SUP (p = 0.000). Twenty-one percent of physicians were high prescribers. High prescribing behavior was associated with hospital grade(p = 0.000), education level(p = 0.010) and attendance at continuing education programs (p = 0.000). Conclusion We found that most surgeons used SUP, primarily proton pump inhibitors. However, surgeons knew little about the SUP guidelines, which may lead to insufficient SUP knowledge and overmedication. In addition, hospital grade, the type of hospital and attendance at continuing education programs may also affect the low knowledge of SUP. Hospital grade, education level and attendance at continuing education programs may affect high prescribing behavior.
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Affiliation(s)
- Xiao Xuan Xing
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, People's Republic of China.,National Clinical Research Center for Geriatric Disorders, Beijing, People's Republic of China
| | - Chen Zhu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Yan Qi Chu
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, People's Republic of China.,National Clinical Research Center for Geriatric Disorders, Beijing, People's Republic of China
| | - Xiang Rong Bai
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, People's Republic of China.,National Clinical Research Center for Geriatric Disorders, Beijing, People's Republic of China
| | - Ke Wang
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, People's Republic of China.,National Clinical Research Center for Geriatric Disorders, Beijing, People's Republic of China
| | - Si Tao Zhang
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, People's Republic of China.,National Clinical Research Center for Geriatric Disorders, Beijing, People's Republic of China
| | - Su Ying Yan
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, People's Republic of China. .,National Clinical Research Center for Geriatric Disorders, Beijing, People's Republic of China.
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Effectiveness of patient decision aids for total hip and knee arthroplasty decision-making: a systematic review. Osteoarthritis Cartilage 2021; 29:1399-1411. [PMID: 34302958 DOI: 10.1016/j.joca.2021.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/22/2021] [Accepted: 07/08/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the effectiveness of patient decision aids (PtDAs) compared to alternative interventions (including usual care) on decision quality and quality of the decision-making process for adults with hip and knee osteoarthritis considering primary elective total joint arthroplasty. METHODS A systematic review guided by Cochrane methods and PRISMA reporting guidelines. Studies were searched in five databases. Included studies were RCTs evaluating the effect of PtDAs on total joint arthroplasty decision-making. Study quality was appraised with Cochrane's risk of bias tool. Quality and strength of recommendations were appraised with GRADE. RESULTS Ten included studies were conducted in North American using the same PtDA. Compared to usual care, PtDA groups demonstrated increased decision quality (e.g., higher knowledge, more informed values-based choices) and quality of the decision making process (e.g., decreased decisional conflict) (6 trials). Secondary outcomes showed increased surgeon satisfaction within the consultation and no difference in patient satisfaction or uptake of the chosen option (surgery: RR 1.03, 95% CI = 0.84 to 1.25; I2 = 66%; 4 trials). When PtDAs formtats were compared, there were similar effects but no difference between PtDAs (4 trials). CONCLUSIONS There was low to very low GRADE certainty of evidence for the effect of PtDAs on decision quality and quality of the decision-making process compared to usual care. No differences were found when different formats of PtDAs were compared (moderate to very low GRADE certainty of evidence).
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Lebedeva Y, Churchill L, Marsh J, MacDonald SJ, Giffin JR, Bryant D. Wait times, resource use and health-related quality of life across the continuum of care for patients referred for total knee replacement surgery. Can J Surg 2021; 64:E253-E264. [PMID: 33908239 PMCID: PMC8327991 DOI: 10.1503/cjs.003419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background The escalating socioeconomic burden of knee osteoarthritis (OA) underscores the need for innovative strategies to reduce wait times for total knee arthroplasty (TKA). The purpose of this study was to evaluate resource use, costs and health-related quality of life (HRQoL) across the continuum of care for patients with knee OA. Methods This was a prospective study of 383 patients recruited from a high-volume teaching hospital at different stages of care (referral, consultation and presurgery). Outcomes included health care resource use; costs captured from the health care payer, private sector and societal perspectives; HRQoL measured using the Western Ontario and McMaster Universities Osteoarthritis Index, the 12-Item Short Form Health Survey, and EuroQoL 5-Dimension 5-Level tool; wait times; and the proportion of referrals deemed suitable candidates for surgery. Results The most commonly used conservative treatments were pharmacotherapy, exercise and lifestyle modification. Forty percent of patients referred for TKA were deemed not to be suitable candidates for surgery. The greatest proportion of costs was borne by the patient or private insurer; a small proportion was borne by the public payer. Across all stages of care, more than 60% of the total costs was attributed to productivity losses. HRQoL remained relatively stable throughout the waiting period (mean wait time from referral to TKA 13.2 mo) but improved postoperatively. Conclusion The suboptimal primary care management of knee OA calls for the development of innovative models of care. This study may provide valuable guidance on the design and implementation of a new online educational platform to improve referral efficiency and expedite wait times for TKA.
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Affiliation(s)
- Yekaterina Lebedeva
- Health and Rehabilitation Sciences Program, Western University, London, Ont. (Lebedeva); School of Physical Therapy, Western University, London, Ont. (Churchill, Marsh, Bryant); Fowler Kennedy Sport Medicine Clinic, London, Ont. (Churchill, Giffin); Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (MacDonald, Giffin); University Hospital, London Health Sciences Centre, London, Ont. (MacDonald); Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Bryant)
| | - Laura Churchill
- Health and Rehabilitation Sciences Program, Western University, London, Ont. (Lebedeva); School of Physical Therapy, Western University, London, Ont. (Churchill, Marsh, Bryant); Fowler Kennedy Sport Medicine Clinic, London, Ont. (Churchill, Giffin); Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (MacDonald, Giffin); University Hospital, London Health Sciences Centre, London, Ont. (MacDonald); Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Bryant)
| | - Jacquelyn Marsh
- Health and Rehabilitation Sciences Program, Western University, London, Ont. (Lebedeva); School of Physical Therapy, Western University, London, Ont. (Churchill, Marsh, Bryant); Fowler Kennedy Sport Medicine Clinic, London, Ont. (Churchill, Giffin); Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (MacDonald, Giffin); University Hospital, London Health Sciences Centre, London, Ont. (MacDonald); Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Bryant)
| | - Steven J MacDonald
- Health and Rehabilitation Sciences Program, Western University, London, Ont. (Lebedeva); School of Physical Therapy, Western University, London, Ont. (Churchill, Marsh, Bryant); Fowler Kennedy Sport Medicine Clinic, London, Ont. (Churchill, Giffin); Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (MacDonald, Giffin); University Hospital, London Health Sciences Centre, London, Ont. (MacDonald); Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Bryant)
| | - J Robert Giffin
- Health and Rehabilitation Sciences Program, Western University, London, Ont. (Lebedeva); School of Physical Therapy, Western University, London, Ont. (Churchill, Marsh, Bryant); Fowler Kennedy Sport Medicine Clinic, London, Ont. (Churchill, Giffin); Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (MacDonald, Giffin); University Hospital, London Health Sciences Centre, London, Ont. (MacDonald); Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Bryant)
| | - Dianne Bryant
- Health and Rehabilitation Sciences Program, Western University, London, Ont. (Lebedeva); School of Physical Therapy, Western University, London, Ont. (Churchill, Marsh, Bryant); Fowler Kennedy Sport Medicine Clinic, London, Ont. (Churchill, Giffin); Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (MacDonald, Giffin); University Hospital, London Health Sciences Centre, London, Ont. (MacDonald); Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Bryant)
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Zarringam D, Saris DB, Bekkers JE. Identification of early prognostic factors for knee and hip arthroplasty; a long-term follow-up of the CHECK cohort. J Orthop 2020; 19:41-45. [PMID: 32021034 DOI: 10.1016/j.jor.2019.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 10/30/2019] [Indexed: 01/14/2023] Open
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Mikkelsen LR, Garval M, Holm C, Skou ST. Improving the referral pattern of patients with knee osteoarthritis to the orthopaedic surgeon: Development and evaluation of a new screening algorithm based on patient-reported data and radiographs. Int J Orthop Trauma Nurs 2019; 35:100706. [PMID: 31434626 DOI: 10.1016/j.ijotn.2019.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Many patients with knee osteoarthritis referred to orthopaedic surgeons are not eligible for surgery and might benefit from being examined by other healthcare professionals. The objective of this study was to develop and test a screening algorithm to define relevant referral to the OS. METHODS Prior to clinical examination, 173 consecutive patients referred to the orthopaedic outpatient clinic completed questionnaires, and radiographic osteoarthritis severity was graded. The gold standard for relevant referral to an orthopaedic surgeon was based on actual treatment. The performance of the algorithm in predicting relevant referrals and total knee replacement (TKR) was assessed using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS Referral to an orthopaedic surgeon was considered relevant in 65% (113/173) of patients. Sensitivity, specificity, PPV and NPV for predicting relevant referral to an orthopaedic surgeon were 0.70, 0.56, 0.76 and 0.48, respectively. The corresponding estimates for predicting TKR surgery were 0.92, 0.56, 0.55 and 0.92. CONCLUSIONS The algorithm was able to identify most patients relevant for referral to an orthopaedic surgeon, but less suitable for identifying those not relevant. The algorithm demonstrated excellent performance in predicting TKR surgery. With further development, this screening algorithm might contribute to improvement of the referral pattern in the orthopaedic outpatient clinic.
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Affiliation(s)
- Lone Ramer Mikkelsen
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1-3, DK-8600, Silkeborg, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - Mette Garval
- Department of Physiotherapy, Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1-3, DK-8600, Silkeborg, Denmark
| | - Carsten Holm
- Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1-3, DK-8600, Silkeborg, Denmark
| | - Søren Thorgaard Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark; Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Fælledvej 11, 4200, Slagelse, Denmark
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Ferguson RJ, Palmer AJ, Taylor A, Porter ML, Malchau H, Glyn-Jones S. Hip replacement. Lancet 2018; 392:1662-1671. [PMID: 30496081 DOI: 10.1016/s0140-6736(18)31777-x] [Citation(s) in RCA: 286] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/22/2018] [Accepted: 07/20/2018] [Indexed: 02/06/2023]
Abstract
Total hip replacement is a frequently done and highly successful surgical intervention. The procedure is undertaken to relieve pain and improve function in individuals with advanced arthritis of the hip joint. Symptomatic osteoarthritis is the most common indication for surgery. In paper 1 of this Series, we focus on how patient factors should inform the surgical decision-making process. Substantial demands are placed upon modern implants, because patients expect to remain active for longer. We discuss the advances made in implant performance and the developments in perioperative practice that have reduced complications. Assessment of surgery outcomes should include patient-reported outcome measures and implant survival rates that are based on data from joint replacement registries. The high-profile failure of some widely used metal-on-metal prostheses has shown the shortcomings of the existing regulatory framework. We consider how proposed changes to the regulatory framework could influence safety.
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Affiliation(s)
- Rory J Ferguson
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Antony Jr Palmer
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Adrian Taylor
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Henrik Malchau
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Sion Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Podmore B, Hutchings A, Durand MA, Robson J, Konan S, van der Meulen J, Lynch R. Comorbidities and the referral pathway to access joint replacement surgery: an exploratory qualitative study. BMC Health Serv Res 2018; 18:754. [PMID: 30285847 PMCID: PMC6171304 DOI: 10.1186/s12913-018-3565-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/24/2018] [Indexed: 11/10/2022] Open
Abstract
Background Variation in access to joint replacement surgery has been widely reported but less attention has been given to the impact of comorbidities on the patient journey to joint replacement surgery. There is a lack of consensus amongst healthcare professionals and commissioners about how patients with comorbidities should be referred or selected for joint replacement surgery. It is therefore important to understand the views of healthcare professionals on the management, referral and selection of patients with comorbidities for joint replacement surgery. Methods An exploratory qualitative study involving semi-structured interviews with 20 healthcare professionals in England across the referral pathway to joint replacement surgery. They were asked to talk about their experiences of referring and selecting patients with comorbidities for joint replacement surgery. The interviews were audio-recorded and transcribed verbatim. Data analysis followed a thematic analysis approach based on the principles of grounded theory. Results In general, the presence of comorbidities was not seen as a barrier to being referred or selected for joint replacement but was seen as a challenge to manage the patients’ journey across the referral pathway. Each professional group, concentrated on different aspects of the patients’ condition which appeared to affect how they managed patients with comorbidities. This implied there was a disagreement about roles and responsibilities in the management of patients with comorbidities. None of the professionals believed it was their responsibility to address comorbidities in preparation for surgery. This disagreement was identified as a reason why some patients seem to ‘get lost’ in the referral system when they were considered to be unprepared for surgery. Patients were then potentially left to manage their own comorbidities before being reconsidered for joint replacement. Conclusions At the clinician-level, comorbidities were not perceived as a barrier to accessing joint replacement surgery but at the pathway-level, it may create an implicit barrier such that patients with comorbidities may get ‘lost’ to the system. Further study is needed to explore the roles and responsibilities of professionals across the current orthopaedic referral pathway which may be less suitable for patients with comorbidities. Electronic supplementary material The online version of this article (10.1186/s12913-018-3565-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bélène Podmore
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. .,Clinical Effectiveness Unit, The Royal College of Surgeons of England, England, UK.
| | - Andrew Hutchings
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.,Clinical Effectiveness Unit, The Royal College of Surgeons of England, England, UK
| | - Mary-Alison Durand
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - John Robson
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Sujith Konan
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Jan van der Meulen
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.,Clinical Effectiveness Unit, The Royal College of Surgeons of England, England, UK
| | - Rebecca Lynch
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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Traumer L, Sørensen EE, Kusk KH, Skou ST. Investigating the motives of patients with knee OA undergoing a TKR: A qualitative interview study. Musculoskeletal Care 2018; 16:380-387. [PMID: 29656439 DOI: 10.1002/msc.1244] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 03/09/2018] [Accepted: 03/11/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Line Traumer
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Erik Elgaard Sørensen
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Søren Thorgaard Skou
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
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