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Ashdown T, Park C, Begum F, Panagiotidou A, Sugand K, El-Tawil S. Do Patients Accurately Represent Their Experiences After Hip and Knee Replacements? Cureus 2021; 13:e12745. [PMID: 33614344 PMCID: PMC7886602 DOI: 10.7759/cureus.12745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background To investigate discrepancies, if any, between the complications that patients report on the patient-reported outcome measures (PROMs) questionnaire and what is formally recorded in their medical records. Methodology A retrospective analysis of PROMs-reported complications was performed at a single elective center for all patients who had an elective primary total knee or hip replacement between April 2016 and March 2017. Corresponding patient medical records were then analyzed to correlate the PROMs with any documentation of postoperative complications, which similar to the PROMs data were categorized into wound complications, urinary complications, readmission, and further operative procedures. Results A set of 54 complete patient records were compared to the corresponding PROMs data. The combined overall positive predictive value was 0.47 while the overall negative predictive value was 0.91. Concordance between patients and the medical records was 70.4% for wound complication, 66.7% for urinary complications, 83.3% for readmission, and 96.3% for reoperation. Conclusion PROMs data are becoming increasingly important in auditing and planning healthcare provision. This study highlights a significant level of discrepancy between the PROMs-reported complication rates and those documented in the medical records. There is a visible disparity between patient perception and the medical definition of postoperative complications. Further patient education and empowerment are required in preparation for arthroplasty.
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Affiliation(s)
- Thomas Ashdown
- Trauma and Orthopaedics, Northwick Park Hospital, London, GBR
| | - Chang Park
- Trauma and Orthopaedics, Northwick Park Hospital, London, GBR
| | - Fahima Begum
- Trauma and Orthopaedics, Northwick Park Hospital, London, GBR
| | | | - Kapil Sugand
- Trauma and Orthopaedics, Northwick Park Hospital, London, GBR
| | - Sherif El-Tawil
- Trauma and Orthopaedics, Northwick Park Hospital, London, GBR
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2
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Heo SM, Harris I, Naylor J, Lewin AM. Complications to 6 months following total hip or knee arthroplasty: observations from an Australian clinical outcomes registry. BMC Musculoskelet Disord 2020; 21:602. [PMID: 32912197 PMCID: PMC7488141 DOI: 10.1186/s12891-020-03612-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/26/2020] [Indexed: 12/11/2022] Open
Abstract
Background Total hip and total knee arthroplasty (THA/TKA) are increasing in incidence annually. While these procedures are effective in improving pain and function, there is a risk of complications. Methods Using data from an arthroplasty registry, we described complication rates including reasons for reoperation and readmission from the acute period to six months following THA and TKA in an Australian context. Data collection at 6 months was conducted via telephone interview, and included patient-reported complications such as joint stiffness, swelling and paraesthesia. We used logistic regression to identify risk factors for complications. Results In the 8444 procedures included for analysis, major complications were reported by 9.5 and 14.4% of THA and TKA patients, respectively, whilst minor complications were reported by 34.0 and 46.6% of THA and TKA patients, respectively. Overall complications rates were 39.7 and 53.6% for THA and TKA patients, respectively. In THA patients, factors associated with increased risk for complications included increased BMI, previous THA and bilateral surgery, whereas in TKA patient factors were heart disease, neurological disease, and pre-operative back pain and arthritis in a separate joint. Female gender and previous TKA were identified as protective factors for minor complications in TKA patients. Conclusion We found moderate rates of major and high rates of minor postoperative complications following THA and TKA in Australia and have identified several patient factors associated with these complications. Efforts should be focused on identifying patients with higher risk and optimising pre- and post-operative care to reduce the rates of these complications.
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Affiliation(s)
- Sung Mu Heo
- Hornsby-Kuringai Hospital, Palmerston Road, Hornsby, Sydney, NSW, 2077, Australia.
| | - Ian Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW, Sydney, Australia
| | - Justine Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW, Sydney, Australia
| | - Adriane M Lewin
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW, Sydney, Australia
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Breeman S, Constable L, Duncan A, Starr K, McDonald A, Wileman S, Cotton S. Verifying participant-reported clinical outcomes: challenges and implications. Trials 2020; 21:241. [PMID: 32131888 PMCID: PMC7057615 DOI: 10.1186/s13063-020-4169-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 02/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background Researchers often rely on trial participants to self-report clinical outcomes (for example, fractures, re-operations). Little information exists as to the ‘accuracy’ of participant-reported clinical outcomes, particularly in randomised controlled trials (RCTs). To help address this evidence gap, we report four case studies, nested within different RCTs where participant-reported clinical outcome data were compared with those reported by clinicians or extracted from medical notes. Methods Four publicly-funded RCTs with different methods of verifying participant-reported outcomes were identified. In KAT, the participants were asked about hospital admissions for any reason. Where it was thought to be relevant to the trial knee, further information was sought from the lead surgeon at the admitting site to confirm whether or not the admission was relevant to the trial knee. In REFLUX, participants were asked about hospital admissions for any reason. For participants who reported a re-operation, further information was sought from the lead surgeon at the admitting site to confirm this. In RECORD, participants were asked three questions regarding broken bones. Where low-trauma fractures were reported, clinical verification was sought, initially from the research nurse at the site. In CATHETER, participants were asked about urinary tract infections (UTIs), and a prescription of antibiotics was provided for the treatment of UTIs following urethral catheterisation. The GPs of those who reported a UTI were contacted to confirm that an antibiotic prescription had been issued for the suspected UTI. Results In KAT, 397 of 6882 (6%) participant-reported hospital admissions were confirmed as relevant to the trial knee. In REFLUX, 16 of 19 participants (84%) who appeared to have had a re-operation were confirmed as having had one. In RECORD, 473 of 781 (61%) fractures reported by participants were confirmed as being low-trauma fractures. In CATHETER, 429 of 830 participant-reported UTIs (52%) were confirmed as such by the GPs. Conclusions We used different approaches in our verification of participant-reported outcomes in clinical trials, and we believe there is no one optimal solution. Consideration of issues such as what information is sought from participants, the phrasing of questions, whether the medical records are a true ‘gold standard’ and costs and benefits to the RCT may help determine the appropriate approach.
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Affiliation(s)
- Suzanne Breeman
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit (HSRU), University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland
| | - Lynda Constable
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit (HSRU), University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland.
| | - Anne Duncan
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit (HSRU), University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland
| | - Kath Starr
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit (HSRU), University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland
| | - Alison McDonald
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit (HSRU), University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland
| | - Samantha Wileman
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit (HSRU), University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland
| | - Seonaidh Cotton
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit (HSRU), University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland
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4
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Carpenter CVE, Wylde V, Moore AJ, Sayers A, Blom AW, Whitehouse MR. Perceived occurrence of an adverse event affects patient-reported outcomes after total hip replacement. BMC Musculoskelet Disord 2020; 21:118. [PMID: 32085754 PMCID: PMC7035750 DOI: 10.1186/s12891-020-3127-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 02/10/2020] [Indexed: 11/14/2022] Open
Abstract
Background Dislocation, periprosthetic fracture and infection are serious complications of total hip replacement (THR) and which negatively impact on patients’ outcomes including satisfaction, quality of life, mental health and function. The accuracy with which patients report adverse events (AEs) after surgery varies. The impact of patient self-reporting of AEs on patient-reported outcome measures (PROMs) after THR is yet to be investigated. Our aim was to determine the effect of confirmed and perceived AEs on PROMs after primary THR. Methods A prospective single-centre cohort study of patients undergoing primary THR, with one-year follow-up, was performed. Participants completed forms pre-operatively and 3, 6, 9 and 12 months post-operatively, including Work Productivity and Activity Impairment (WPAI), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EuroQol-5D-3 L (EQ5D), Self-Administered Patient Satisfaction (SAPS) and AE reporting questionnaires. Results were reported in three groups: No AE, reported but not confirmed AE and confirmed AE. A generalised linear model was used to compare among groups using robust standard errors (SE). Results Forty-one AEs were reported in a cohort of 417 patients (234 females), with 30 AEs reported by 3 months. Eleven (27 reported) infections, two (six reported) periprosthetic fractures and two (eight reported) dislocations were confirmed. Those in the no AE group reported significantly better outcomes that the reported AE group as measured by WOMAC Co-Eff 14.27 (p = 0.01), EQ5D − 0.128 (p = 0.02) and SAPS − 9.926 (p = 0.036) and the combined reported and confirmed AE groups as measured by WOMAC Co-Eff 13.72 (p = 0.002), EQ5D − 0.129 (p = 0.036) and SAPS − 11.512 (p = 0.004). No significant differences were seen in WPAI among groups. Conclusions Patients who report AEs have worse outcomes than those who do not, regardless of whether the AEs can be confirmed by standard medical record review methods. The observed negative trends suggest that patient perception of AEs may influence patient outcome in a similar way to those with confirmed AEs.
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Affiliation(s)
- Charlotte V E Carpenter
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Vikki Wylde
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Andrew J Moore
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
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Dang KLT, Badge H, Harris IA. Validity of patient-reported complications after total hip and knee arthroplasty. J Orthop Surg (Hong Kong) 2019; 26:2309499018802493. [PMID: 30270744 DOI: 10.1177/2309499018802493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Evaluating the effectiveness of total hip arthroplasty (THA) and total knee arthroplasty (TKA) often relies on accurate patient reporting of postoperative complications. Despite this, there is little research regarding the accuracy of patient reports. We aimed to determine the accuracy of patient-reported significant complications after THA and TKA. METHODS Patients were recruited prior to undergoing primary hip or knee arthroplasty at 19 high-volume hospitals. After surgery, follow-up of patients via telephone interviews at 35, 90 and 365 days recorded surgical outcomes including readmission, reoperation and venous thromboembolism (VTE). Patient-reported complications were verified via medical record audits and liaison with surgeons, general practitioners or other health professionals. Surgical and demographic information and patient-reported and verified complications were entered into a database. Patient-reported and verified complications were compared for readmission, reoperation and VTE. RESULTS The sample included 150 of 1811 patients who reported a total of 242 significant complications. Of the 242 patient-reported complications, 224 (92.6%) were correct (true positive). The type of complication had variable levels of accuracy in patient reports. Readmission to hospital was accurately reported by 90.2% (129/143) of patients. Reoperation (including any manipulations under anaesthesia, joint washouts, reductions of dislocated joints and revisions) was accurately reported by 98.7% (75/76) of patients. VTE was accurately reported by 86.7% (20/23) of patients. CONCLUSION A high level of accuracy in patient-reported experience of complications was demonstrated following THA and TKA. Patient-reported complications may be reliably used for post-operative surveillance of joint replacement surgery.
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Affiliation(s)
- Kinh Luan Thanh Dang
- 1 Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, New South Wales, Australia
| | - Helen Badge
- 1 Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, New South Wales, Australia.,2 NSW Agency for Clinical Innovation, Chatswood, New South Wales, Australia
| | - Ian A Harris
- 1 Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, New South Wales, Australia
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6
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Dokter EM, Goosen EE, van der Zanden LF, Kortmann BB, de Gier RP, Roeleveld N, Feitz WF, van Rooij IA. Level of agreement on postoperative complications after one-stage hypospadias correction comparing medical records and parent reports. J Pediatr Surg 2019; 54:1825-1831. [PMID: 30850151 DOI: 10.1016/j.jpedsurg.2019.01.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/10/2019] [Accepted: 01/12/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE To analyze agreement on postoperative complications after hypospadias surgery according to medical records and parents' reports. MATERIALS & METHODS In this retrospective cohort study, data were collected from 409 children who received an initial one-stage hypospadias correction in the Radboudumc, The Netherlands. Postoperative complications according to medical records were compared with parent-reported complications in an online questionnaire. Main complications studied were wound-related complications, urinary tract infections, fistulas, stenosis, and prepuce-related complications. Agreement was determined by Cohen's kappa coefficient. RESULTS Slightly less complications were mentioned in medical records (37%) compared to parents' reports (42%). Overall agreement was moderate (κ = 0.50, 95% confidence interval (CI):0.41-0.59), but poor for some specific complications. Agreement was higher for complications that needed reoperation compared to when no reoperation was performed (κ = 0.53, 95% CI: 0.43-0.62 and κ = 0.18, 95% CI: 0.06-0.31) and for patients with recent surgery (<5 years before questionnaire completion) compared to less recent surgeries (κ = 0.69, 95% CI: 0.55-0.84 and κ = 0.43, 95% CI: 0.33-0.54). CONCLUSIONS Agreement on complications according to medical records and parents' reports was poor to moderate, but better after reoperation and more recent surgery. Some complications mentioned in medical records were missing from parents' reports and the other way around. Better agreement will give physicians and parents a more reliable view on postoperative outcome after hypospadias surgery. TYPE OF STUDY Diagnostic test. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Elisabeth Mj Dokter
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Evelina Ec Goosen
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Urology, Pediatric Urology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Loes Fm van der Zanden
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Barbara Bm Kortmann
- Department of Urology, Pediatric Urology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Robert Pe de Gier
- Department of Urology, Pediatric Urology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Nel Roeleveld
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wout Fj Feitz
- Department of Urology, Pediatric Urology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Iris Alm van Rooij
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
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7
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Heo SM, Naylor JM, Harris IA, Churches TR. Reliability of patient-reported complications following hip or knee arthroplasty procedures. BMC Med Res Methodol 2019; 19:15. [PMID: 30634917 PMCID: PMC6330452 DOI: 10.1186/s12874-018-0645-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/17/2018] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Sung Mu Heo
- South Western Sydney Clinical School, UNSW Sydney, Level 2, Clinical Building, Liverpool Hospital, Cnr Elizabeth and Goulburn Sts, Liverpool NSW, 2170 Australia
| | - Justine M. Naylor
- South Western Sydney Clinical School, UNSW Sydney, Level 2, Clinical Building, Liverpool Hospital, Cnr Elizabeth and Goulburn Sts, Liverpool NSW, 2170 Australia
- Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool NSW, 2170 Australia
- Whitlam Orthopaedics Research Centre, Level 2, 1 Campbell St, Liverpool NSWl, 2170 Australia
| | - Ian A. Harris
- South Western Sydney Clinical School, UNSW Sydney, Level 2, Clinical Building, Liverpool Hospital, Cnr Elizabeth and Goulburn Sts, Liverpool NSW, 2170 Australia
- Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool NSW, 2170 Australia
- Whitlam Orthopaedics Research Centre, Level 2, 1 Campbell St, Liverpool NSWl, 2170 Australia
| | - Timothy R. Churches
- South Western Sydney Clinical School, UNSW Sydney, Level 2, Clinical Building, Liverpool Hospital, Cnr Elizabeth and Goulburn Sts, Liverpool NSW, 2170 Australia
- Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool NSW, 2170 Australia
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8
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Rosner BI, Gottlieb M, Anderson WN. Accuracy of Internet-Based Patient Self-Report of Postdischarge Health Care Utilization and Complications Following Orthopedic Procedures: Observational Cohort Study. J Med Internet Res 2018; 20:e10405. [PMID: 30030212 PMCID: PMC6076369 DOI: 10.2196/10405] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/23/2018] [Accepted: 06/21/2018] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Benjamin I Rosner
- HealthLoop Inc, Mountain View, CA, United States.,Department of Hospital Medicine, Kaiser Permanente, Santa Clara, CA, United States
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9
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Fritz BA, Escallier KE, Ben Abdallah A, Oberhaus J, Becker J, Geczi K, McKinnon S, Helsten DL, Sharma A, Wildes TS, Avidan MS. Convergent Validity of Three Methods for Measuring Postoperative Complications. Anesthesiology 2016; 124:1265-76. [PMID: 27028469 PMCID: PMC5083125 DOI: 10.1097/aln.0000000000001108] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Anesthesiologists need tools to accurately track postoperative outcomes. The accuracy of patient report in identifying a wide variety of postoperative complications after diverse surgical procedures has not previously been investigated. METHODS In this cohort study, 1,578 adult surgical patients completed a survey at least 30 days after their procedure asking if they had experienced any of 18 complications while in the hospital after surgery. Patient responses were compared to the results of an automated electronic chart review and (for a random subset of 750 patients) to a manual chart review. Results from automated chart review were also compared to those from manual chart review. Forty-two randomly selected patients were contacted by telephone to explore reasons for discrepancies between patient report and manual chart review. RESULTS Comparisons between patient report, automated chart review, and manual chart review demonstrated poor-to-moderate positive agreement (range, 0 to 58%) and excellent negative agreement (range, 82 to 100%). Discordance between patient report and manual chart review was frequently explicable by patients reporting events that happened outside the time period of interest. CONCLUSIONS Patient report can provide information about subjective experiences or events that happen after hospital discharge, but often yields different results from chart review for specific in-hospital complications. Effective in-hospital communication with patients and thoughtful survey design may increase the quality of patient-reported complication data.
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Affiliation(s)
- Bradley A Fritz
- From the Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
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10
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Vulvar necrosis after surgical treatment of femoral neck fracture: a case report and investigation of the mechanism of injury. Hip Int 2016; 26:e4-6. [PMID: 26351117 DOI: 10.5301/hipint.5000283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 02/04/2023]
Abstract
We report the case of a young patient, presenting with total bilateral vulvar necrosis after reduction of a femoral neck fracture. This report describes the management of this complication, its mechanism of injury and the associated means of prevention. We present an investigation of the vulvar vasculature in order to understand the mechanism of injury.The study of the vulvar vasculature rejects the anatomical hypothesis of selective damage to the internal and external arteries. Instead, it suggests intraoperative impingement of the terminal blood vessels caused by compression against the perineal post prompting discussion on the use of moulded countertraction posts during orthopaedic surgery.
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Boyce MB, Browne JP, Greenhalgh J. Surgeon's experiences of receiving peer benchmarked feedback using patient-reported outcome measures: a qualitative study. Implement Sci 2014; 9:84. [PMID: 24972784 PMCID: PMC4227108 DOI: 10.1186/1748-5908-9-84] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 06/17/2014] [Indexed: 11/10/2022] Open
Abstract
Background The use of patient-reported outcome measures (PROMs) to provide healthcare professionals with peer benchmarked feedback is growing. However, there is little evidence on the opinions of professionals on the value of this information in practice. The purpose of this research is to explore surgeon’s experiences of receiving peer benchmarked PROMs feedback and to examine whether this information led to changes in their practice. Methods This qualitative research employed a Framework approach. Semi-structured interviews were undertaken with surgeons who received peer benchmarked PROMs feedback. The participants included eleven consultant orthopaedic surgeons in the Republic of Ireland. Results Five themes were identified: conceptual, methodological, practical, attitudinal, and impact. A typology was developed based on the attitudinal and impact themes from which three distinct groups emerged. ‘Advocates’ had positive attitudes towards PROMs and confirmed that the information promoted a self-reflective process. ‘Converts’ were uncertain about the value of PROMs, which reduced their inclination to use the data. ‘Sceptics’ had negative attitudes towards PROMs and claimed that the information had no impact on their behaviour. The conceptual, methodological and practical factors were linked to the typology. Conclusion Surgeons had mixed opinions on the value of peer benchmarked PROMs data. Many appreciated the feedback as it reassured them that their practice was similar to their peers. However, PROMs information alone was considered insufficient to help identify opportunities for quality improvements. The reasons for the observed reluctance of participants to embrace PROMs can be categorised into conceptual, methodological, and practical factors. Policy makers and researchers need to increase professionals’ awareness of the numerous purposes and benefits of using PROMs, challenge the current methods to measure performance using PROMs, and reduce the burden of data collection and information dissemination on routine practice.
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Affiliation(s)
- Maria B Boyce
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
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Khoriati AA. Total hip arthroplasty with acetabular fixation: an unexpected complication. Orthopedics 2014; 37:e407-9. [PMID: 24762850 DOI: 10.3928/01477447-20140401-66] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 10/09/2013] [Indexed: 02/03/2023]
Abstract
The incidence of vascular injuries associated with total hip arthroplasty (THA) is low. However, several vascular structures are at risk of injury within the pelvis. These include the external iliac, femoral, and obturator vessels. Both reaming of the acetabulum and drilling of the acetabular screw holes may place these structures at risk. If left untreated, injuries to these vessels may be associated with severe morbidity and mortality. In this report, an acute vascular complication that had an unusual presentation is highlighted. A 72-year-old woman presented to the emergency department following a road traffic accident in which she sustained a combined fracture of the right acetabulum and femoral head. Her treatment involved a combination of THA and pelvic open reduction and internal fixation. The immediate perioperative recovery period was uncomplicated. However, the patient developed a deep venous thrombus in her right calf 7 days after surgery. Further investigation revealed a second thrombus, occluding the right common femoral vein. Surgical exploration revealed that a screw placed during the initial surgery was pressing against the vessel and occluding it. The discrepancy in incidence between the development of deep venous thrombosis and vascular compression or injury means that the association between the 2 events is unlikely to be made. The author highlights this unusual presentation to improve early recognition and prompt management of similar cases. The importance of adequate preoperative planning and intraoperative imaging with a C-arm is also stressed.
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Iyer R, Gentry-Maharaj A, Nordin A, Liston R, Burnell M, Das N, Desai R, Gornall R, Beardmore-Gray A, Hillaby K, Leeson S, Linder A, Lopes A, Meechan D, Mould T, Nevin J, Olaitan A, Rufford B, Ryan A, Shanbhag S, Thackeray A, Wood N, Reynolds K, Menon U. Patient-reporting improves estimates of postoperative complication rates: a prospective cohort study in gynaecological oncology. Br J Cancer 2013; 109:623-32. [PMID: 23846170 PMCID: PMC3738134 DOI: 10.1038/bjc.2013.366] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 06/16/2013] [Accepted: 06/22/2013] [Indexed: 12/04/2022] Open
Abstract
Background: Most studies use hospital data to calculate postoperative complication rates (PCRs). We report on improving PCR estimates through use of patient-reporting. Methods: A prospective cohort study of major surgery performed at 10 UK gynaecological cancer centres was undertaken. Hospitals entered the data contemporaneously into an online database. Patients were sent follow-up letters to capture postoperative complications. Grade II–V (Clavien–Dindo classification) patient-reported postoperative complications were verified from hospital records. Postoperative complication rate was defined as the proportion of surgeries with a Grade II–V postoperative complication. Results: Patient replies were received for 1462 (68%) of 2152 surgeries undertaken between April 2010 and February 2012. Overall, 452 Grade II–V (402 II, 50 III–V) complications were reported in 379 of the 1462 surgeries. This included 172 surgeries with 200 hospital-reported complications and 231 with 280 patient-reported complications. All (100% concordance) 36 Grade III–V and 158 of 280 (56.4% concordance) Grade II patient-reported complications were verified on hospital case-note review. The PCR using hospital-reported data was 11.8% (172 out of 1462; 95% CI 11–14), patient-reported was 15.8% (231 out of 1462; 95% CI 14–17.8), hospital and verified patient-reported was 19.4% (283 out of 1462; 95% CI 17.4–21.4) and all data were 25.9% (379 out of 1462; 95% CI 24–28). After excluding Grade II complications, the hospital and patient verified Grade III–V PCR was 3.3% (48 out of 1462; 95% CI 2.5–4.3). Conclusion: This is the first prospective study of postoperative complications we are aware of in gynaecological oncology to include the patient-reported data. Patient-reporting is invaluable for obtaining complete information on postoperative complications. Primary care case-note review is likely to improve verification rates of patient-reported Grade II complications.
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Affiliation(s)
- R Iyer
- University College, London, UK
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Pieterse QD, Ter Kuile MM, Maas CP, Kenter GG. The Gynaecologic Leiden Questionnaire: psychometric properties of a self-report questionnaire of sexual function and vaginal changes for gynaecological cancer patients. Psychooncology 2008; 17:681-9. [PMID: 17992699 PMCID: PMC4801326 DOI: 10.1002/pon.1294] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The aim of this study was to investigate the psychometric properties of the items concerning sexual functioning of the Gynaecologic Leiden Questionnaire (LQ), which consists of items for post operative morbidity for women with cancer. METHODS The total study sample consisted of 198 subjects: 66 patients treated for cervical cancer, 66 patients with sexual complaints and 66 subjects from the general population. RESULTS By means of factor analysis three subscales were derived: Female Sexual Complaints, Female Sexual Function and Female Orgasm. The reliability of the subscales appeared to be satisfactory. The scores on the three subscales differentiated well between the patients treated for cervical cancer, patients with sexual complaints and the subjects from the general population. Furthermore, the subscales were sensitive to changes within the patients treated for cervical cancer. The convergent and divergent construct validities of the LQ were investigated using other instruments measuring sexual functioning, sexual dissatisfaction, marital distress, general life distress and psychological distress. The LQ subscales were found to represent relatively independent constructs. CONCLUSION The results support the reliability and psychometric validity of the LQ in the assessment of sexual functioning and vaginal changes in gynaecological cancer patients.
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Affiliation(s)
- Q D Pieterse
- Department of Gynaecology, Leiden University Medical Center, Leiden, The Netherlands. Q.
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