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Kunze KN, Williams RJ, Ranawat AS, Pearle AD, Kelly BT, Karlsson J, Martin RK, Pareek A. Artificial intelligence (AI) and large data registries: Understanding the advantages and limitations of contemporary data sets for use in AI research. Knee Surg Sports Traumatol Arthrosc 2024; 32:13-18. [PMID: 38226678 DOI: 10.1002/ksa.12018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/27/2023] [Indexed: 01/17/2024]
Affiliation(s)
- Kyle N Kunze
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Riley J Williams
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Anil S Ranawat
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Andrew D Pearle
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Bryan T Kelly
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - R Kyle Martin
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ayoosh Pareek
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
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Acupuncture Case Registry Study: Rationale, Implementations, and Achievements. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3860231. [DOI: 10.1155/2022/3860231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/10/2022] [Indexed: 11/22/2022]
Abstract
The acupuncture case registry study is focusing on acupuncture therapy data from patient cases. The main objective is to collect real-world data and integrate clinically meaningful outcome evaluation indicators to uncover and evaluate real-world acupuncture efficacy and safety, explore factors affecting acupuncture efficacy, and provide real-world evidence to complement RCTs. Since the International Acupuncture Case Registry data collection system’s establishment in 2017, 16 projects have been underway, including two acupuncture specialty therapies and 15 diseases. Data from 3404 patients included extensive information on the diagnosis and treatment of acupuncture and the evaluation of its efficacy. In order to serve as a guide for future studies, this article discusses the value of and rationale for establishing acupuncture case registry studies, how to distinguish them from patient registries, and crucial techniques for implementing registry studies in terms of applications, patient recruitment, costakeholder collaboration, data collection and management, study quality control, and ethics.
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Möller M, Wolf O, Bergdahl C, Mukka S, Rydberg EM, Hailer NP, Ekelund J, Wennergren D. The Swedish Fracture Register - ten years of experience and 600,000 fractures collected in a National Quality Register. BMC Musculoskelet Disord 2022; 23:141. [PMID: 35148730 PMCID: PMC8832767 DOI: 10.1186/s12891-022-05062-w] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Before the creation of the Swedish Fracture Register (SFR), there was no national quality register that prospectively collects data regarding all types of fractures regardless of treatment in an emergency setting. Observational data on fractures registered in a sustainable way may provide invaluable tools for quality improvements in health care and research. DESCRIPTION Ten years after its implementation, the Swedish Fracture Register has 100% coverage among orthopaedic and trauma departments in Sweden. The completeness of registrations reached in 2020 69-96% for hip fractures at the different departments, with the majority reporting a completeness above 85%. The Swedish Fracture Register is a fully web-based national quality register created and run by orthopaedic professionals, with financial support from public healthcare providers and the government. All users have full access to both the registration platform and all aggregated statistics in real time. The web-based platform was created for use in health quality registers and it has easily gained acceptance among users. The register has gradually developed by the addition of more fracture types and skeletal parts. Research activity is high and 31 scientific publications have been published since 2016. The strategy from the start was to publish validation data and basic epidemiological data. However, over the past few years, publications on outcomes, such as re-operations and mortality, have been published and four register-based, randomised, controlled trials are ongoing. CONCLUSION It is possible to create a fracture register, to gain professional acceptance and to collect fracture data in a sustainable way on a national level if the platform is easy to use. Such a platform can also be used as a randomisation platform for prospective studies.
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Affiliation(s)
- Michael Möller
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden.
| | - Olof Wolf
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Carl Bergdahl
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| | - Sebastian Mukka
- Department of Surgical and Perioperative Science (Orthopaedics), Umeå University, Umeå, Sweden
| | - Emilia Möller Rydberg
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| | - Nils P Hailer
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Jan Ekelund
- Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - David Wennergren
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
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Visvanathan A, Wilson C, Jackman E, Wong G, Krishnan J. Design, Construction, and Early Results of a Formal Local Revision Knee Arthroplasty Registry. J Knee Surg 2021; 34:1284-1295. [PMID: 32294773 DOI: 10.1055/s-0040-1708040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
National registries for primary and revision knee arthroplasty in Australia, New Zealand, and Europe have been successful in ensuring quality control and providing information to drive crucial research. However, they face challenges in delivering the granularity of data useful at a local hospital level. Our aim was to address these challenges by designing and initiating a local revision knee arthroplasty registry and combining the data with national figures to better evaluate the types of revisions undertaken, and improve patient outcomes and care. All revision knee arthroplasty cases in our center were analyzed from April 2014 to December 2015 using our standardized diagnostic algorithm. Information such as reason and type of revision was collected. Results were compared with Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) data. Primary outcome was comparison against our center's historical data between January 1999 and December 2013 and secondary outcome was comparison against national data prior to and after our intervention. Between April 2014 and December 2015, our center performed 35 revision knee arthroplasties. When compared with our center's historical data, we observed lower rates of revision knee arthroplasties due to "pain" (14.2 vs. 36.7%) with corresponding lower rates of patella button only revision (8.6 vs. 39.2%). Compared with national data before our intervention, we had lower revision rates from infection (14.2 vs. 22.3%) and loosening/lysis (11.4 vs. 29.2%). We undertook more minor revisions (45.7 vs. 30.5%) and similar total revisions (25.7 vs. 25.3%). Similar trends were seen in comparison to national data after our intervention. Our study shows that a local registry can be designed and successfully implemented for revision knee arthroplasty surgery. Data can be easily compared with historic and current hospital and national registry data trends to assess quality and robustness of revision arthroplasty programs. Our early results suggest our center has succeeded in reducing incidences of major revisions, complications, and the risk of re-revision surgery. This will improve the quality of our service with a significant cost reduction for our local health care budget.
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Affiliation(s)
- Aravinthan Visvanathan
- Department of Orthopaedics and Trauma Surgery, The Repatriation General Hospital Adelaide (RGH), Daw Park, South Australia, Australia
| | - Christopher Wilson
- Department of Orthopaedics and Trauma Surgery, The Repatriation General Hospital Adelaide (RGH), Daw Park, South Australia, Australia
| | - Emma Jackman
- Department of Orthopaedics, Flinders University Adelaide, Bedford Park, South Australia, Australia
| | - Geraldine Wong
- Department of Orthopaedics, Flinders University Adelaide, Bedford Park, South Australia, Australia
| | - Jegan Krishnan
- Department of Orthopaedics and Trauma Surgery, The Repatriation General Hospital Adelaide (RGH), Daw Park, South Australia, Australia
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Lee B, Ebrahimi M, Ektas N, Ting CH, Cowley M, Scholes C, Bell C. Implementation and quality assessment of a clinical orthopaedic registry in a public hospital department. BMC Health Serv Res 2020; 20:393. [PMID: 32386523 PMCID: PMC7210668 DOI: 10.1186/s12913-020-05203-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to demonstrate a novel method of assessing data quality for an orthopaedic registry and its effects on data quality metrics. METHODS A quality controlled clinical patient registry was implemented, comprising six observational cohorts of shoulder and knee pathologies. Data collection procedures were co-developed with clinicians and administrative staff in accordance with the relevant dataset and organised into the registry database software. Quality metrics included completeness, consistency and validity. Data were extracted at scheduled intervals (3 months) and quality metrics reported to stakeholders of the registry. RESULTS The first patient was enrolled in July 2017 and the data extracted for analysis over 4 quarters, with the last audit in August 2018 (N = 189). Auditing revealed registry completeness was 100% after registry deficiencies were addressed. However, cohort completeness was less accurate, ranging from 12 to 13% for height & weight to 90-100% for operative variables such as operating surgeon, consulting surgeon and hospital. Consistency and internal validation improved to 100% after issues in registry processes were rectified. CONCLUSIONS A novel method to assess data quality in a clinical orthopaedic registry identified process shortfalls and improved data quality over time. Real-time communication, a comprehensive data framework and an integrated feedback loop were necessary to ensure adequate quality assurance. This model can be replicated in other registries and serve as a useful quality control tool to improve registry quality and ensure applicability of the data to aid clinical decisions, especially in newly implemented registries. TRIAL REGISTRATION ACTRN12617001161314; registration date 8/08/2017. Retrospectively registered.
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Affiliation(s)
- Binglong Lee
- Orthopaedics Department, QEII Jubilee Hospital, Coopers Plains, Queensland, Australia
| | | | - Nalan Ektas
- EBM Analytics, Crows Nest, NSW, 2065, Australia
| | - Chee Han Ting
- Orthopaedics Department, QEII Jubilee Hospital, Coopers Plains, Queensland, Australia
| | | | | | - Christopher Bell
- Orthopaedics Department, QEII Jubilee Hospital, Coopers Plains, Queensland, Australia.
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6
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Bolz NJ, Zarling BJ, Markel DC. Long-Term Sustainability of a Quality Initiative Program on Transfusion Rates in Total Joint Arthroplasty: A Follow-Up Study. J Arthroplasty 2020; 35:340-346. [PMID: 31548114 DOI: 10.1016/j.arth.2019.08.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/16/2019] [Accepted: 08/27/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There are significant variations in transfusion rates among institutions performing total joint arthroplasty. We previously demonstrated that implementation of an educational program to increase awareness of the American Association of Blood Banks' transfusion guidelines led to an immediate decrease in transfusion rates at our facilities. It remained unclear how this initiative would endure over time. We report the long-term success and sustainability of this quality program. METHODS We reviewed the Michigan Arthroplasty Collaborative Quality Initiative data from 2012 through 2017 of all patients undergoing primary hip and knee arthroplasty at our institutions for preoperative and postoperative hemoglobin level, transfusion status, and number of units transfused and transfusions outside of protocol to identify changes surrounding our blood transfusion educational initiative. We calculated the transfusions prevented and cost implications over the course of the study. RESULTS We identified 6645 primary hip and knee arthroplasty patients. There was a significant decrease in transfusion rate and overall transfusions in each group when compared to pre-education values. Subgroup analysis of TKA and THA independently showed significant decreases in both transfusion rate and overall transfusions. Over the final 3 years of the study, only 2 patients were transfused outside of the American Association of Blood Banks protocol. We estimate prevention of 519 transfusions over the study period. CONCLUSION Application of this quality initiative was an effective means of identifying opportunities for quality improvement. The program was easily initiated, had significant early impact, and has been shown to be sustainable.
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Affiliation(s)
- Nicholas J Bolz
- Section of Orthopaedic Surgery, Ascension Providence Hospital, Novi, MI; Detroit Medical Center/Wayne State University Orthopedic Residency Program, Detroit, MI
| | - Bradley J Zarling
- Section of Orthopaedic Surgery, Ascension Providence Hospital, Novi, MI; Detroit Medical Center/Wayne State University Orthopedic Residency Program, Detroit, MI
| | - David C Markel
- Section of Orthopaedic Surgery, Ascension Providence Hospital, Novi, MI; Detroit Medical Center/Wayne State University Orthopedic Residency Program, Detroit, MI; The Core Institute, Novi, MI
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Kim HJ, Lee SJ, Hyun JK, Kim SY, Kim TU. Influence of Hip Fracture on Knee Pain During Postoperative Rehabilitation. Ann Rehabil Med 2018; 42:682-689. [PMID: 30404417 PMCID: PMC6246861 DOI: 10.5535/arm.2018.42.5.682] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 06/12/2018] [Indexed: 11/28/2022] Open
Abstract
Objective To investigate whether fracture type, surgical procedure, or fracture grade affect knee pain during postoperative rehabilitation after a hip fracture. Methods We conducted a retrospective case-controlled study of 139 patients during postoperative rehabilitation after surgery for hip fractures. Patients were divided into two groups: patients experiencing knee pain during the first week of postoperative rehabilitation, and patients without knee pain. We compared the types of fracture, surgical procedure, and fracture grade between the two groups. Results We enrolled 52 patients (37.4%) with knee pain during the first weeks of postoperative rehabilitation. For type of fracture, knee pain was more common with intertrochanteric fracture than with femur neck fracture (48.8% vs. 21.1%, respectively; p=0.001). For the surgical procedure, there was no significant difference between the groups. For the fracture grade, the grades classified as unstable fractures were more common in the group of intertrochanteric fracture patients with knee pain than in those without knee pain (74.1% vs. 36.4%, respectively; p=0.002). Conclusion Intertrochanteric fracture affected knee pain after hip fracture surgery more than did femur neck fracture, particularly in unstable fractures. Furthermore, there was no difference in each fracture type according to the surgical procedure. Careful examination and management for knee pain is needed in patients with hip fracture surgery.
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Affiliation(s)
- Hee-Ju Kim
- Department of Rehabilitation Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Seong Jae Lee
- Department of Rehabilitation Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Jung Keun Hyun
- Department of Rehabilitation Medicine, Dankook University College of Medicine, Cheonan, Korea.,Department of Nanobiomedical Science & WCU Research Center, Dankook University, Cheonan, Korea.,Institute of Tissue Regeneration Engineering, Dankook University, Cheonan, Korea
| | - Seo-Young Kim
- Department of Rehabilitation Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Tae Uk Kim
- Department of Rehabilitation Medicine, Dankook University College of Medicine, Cheonan, Korea
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Sayeed Z, El-Othmani MM, Anoushiravani AA, Chambers MC, Saleh KJ. Planning, Building, and Maintaining a Successful Musculoskeletal Service Line. Orthop Clin North Am 2016; 47:681-8. [PMID: 27637654 DOI: 10.1016/j.ocl.2016.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Within the past 3 decades, a recent trend in the growth of musculoskeletal service lines has been seen nationally. Orthopedics offers an appealing concourse for implementation of service-line care. Within this review, the authors address the components involved in planning and building a musculoskeletal service line. The authors also address methods by which orthopedic surgeons can maintain the efficacy of their service lines by examining how orthopedic surgeons can navigate their service line through recent advents in health care reform. Finally, the authors review successful examples of musculoskeletal service lines currently in practice within the orthopedic community.
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Affiliation(s)
- Zain Sayeed
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Mouhanad M El-Othmani
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Afshin A Anoushiravani
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Monique C Chambers
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Khaled J Saleh
- Department of Orthopaedic and Sports Medicine, Detroit Medical Center, 311 Mack Avenue, 5th Floor, Detroit, MI 48201, USA.
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Ceyhan E, Gursoy S, Akkaya M, Ugurlu M, Koksal I, Bozkurt M. Toward the Turkish National Registry System: A Prevalence Study of Total Knee Arthroplasty in Turkey. J Arthroplasty 2016; 31:1878-84. [PMID: 27038864 DOI: 10.1016/j.arth.2016.02.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/20/2016] [Accepted: 02/11/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of this pilot study was to analyze the data obtained from a retrospective examination of the records of the existing reimbursement system and through the identification of gaps in the data to create a foundation for a reliable, descriptive national registry system for our country. METHODS The Social Security Institution Medical Messenger (MEDULA) records were scanned for the years 2010-2014, and the numbers of total knee arthroplasty applied for a diagnosis of gonarthrosis and the numbers of revision knee arthroplasty were recorded for the country in general. The patients were classified according to age, gender, and bilateral or unilateral surgery. The institution where the surgery was applied, the geographic region and the province were also recorded. RESULTS A total of 283,400 primary and 9900 revision knee arthroplasty operations were applied in Turkey between 2010 and 2014. Numbers were recorded for each year, and there was found to be an increase between years. For primary knee arthroplasty, the female:male ratio was 67 of 33, and surgery was applied most often between the ages of 60-69 years. Both types of surgery were determined to have been applied most often in second-stage state hospitals. Geographically, both types of surgery were applied most in the Marmara region, with the highest frequency of primary knee arthroplasty in Istanbul and the highest frequency of revision surgery in Ankara. CONCLUSIONS The data obtained from this study will contribute to the creation of the basis for a National Registry System and thereby define more scientific treatment approaches.
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Affiliation(s)
- Erman Ceyhan
- Republic of Turkey Social Security Institution, General Directorate of General Health Insurance, Ankara, Turkey
| | - Safa Gursoy
- Department of Orthopedics and Traumatology, Yenimahalle Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Mustafa Akkaya
- Department of Orthopedics and Traumatology, Yenimahalle Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Mahmut Ugurlu
- Department of Orthopedics and Traumatology, Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Ismet Koksal
- Republic of Turkey Social Security Institution, General Directorate of General Health Insurance, Ankara, Turkey
| | - Murat Bozkurt
- Department of Orthopedics and Traumatology, Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
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Markel DC, Allen MW, Zappa NM. Can an Arthroplasty Registry Help Decrease Transfusions in Primary Total Joint Replacement? A Quality Initiative. Clin Orthop Relat Res 2016; 474:126-31. [PMID: 26215083 PMCID: PMC4686507 DOI: 10.1007/s11999-015-4470-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Standardized care plans are effective at controlling cost and quality. Registries provide insights into quality and outcomes for use of implants, but most registries do not combine implant and care quality data. In 2012, several Michigan area hospitals and a major insurance provider formed a voluntary statewide total joint database/registry, the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), to collect procedural, hospital, discharge, and readmission data. Noting substantial variation in transfusion practices after total joint arthroplasty (TJA) in our institutions, we used these prospectively collected data to examine whether awareness and education of the American Association of Blood Banks' (AABB) transfusion guidelines would result in decreased transfusions. QUESTIONS/PURPOSES (1) Can an established arthroplasty registry help implement a quality initiative (QI) designed to decrease the proportion of transfused postoperative patients undergoing TJA? (2) Do data-driven transfusion protocols decrease length of stay without increasing ischemic complications (myocardial infarctions and cerebrovascular accidents)? (3) Are decreased transfusion proportions associated with decreased readmissions, nonischemic morbidity (including deep vein thrombosis and deep prosthetic infection), and mortality in postoperative patients who had undergone TJA? METHODS After reviewing data from the recently established MARCQI registry, the orthopaedic department noticed many discrepancies and practice variances regarding blood transfusions among their providers. In October 2013, a QI was implemented to raise awareness of the discrepancies and education about the AABB guidelines was presented at the monthly orthopaedic service line meeting. A total of 1872 TJA cases were reviewed; 50 were excluded for incomplete data and two for intraoperative transfusions for the period before education (May 2012 to June 2013, n = 1240) and after education (November 2013 to April 2014, n = 580). Data collected included gender, age, length of stay, body mass index, preoperative hemoglobin level, lowest postoperative hemoglobin level during admission, transfusion status, number of units transfused, ischemic and nonischemic morbidity, hospital readmissions within 90 days, and mortality. Pre- and post-QI transfusion proportions were calculated. Chi-square test, Student's t-test, and a multivariate analysis were performed to compare differences in transfusion proportions for patients with a postoperative hemoglobin ≥ 8 g/dL. RESULTS Overall, the percentage of patients transfused with a postoperative hemoglobin ≥ 8 g/dL decreased 80% (6.5% [71 of 1092] versus 1.3% [seven of 538]; odds ratio, 5.3; 95% confidence interval, 2.4-11.6; p < 0.001) after the educational intervention. Before education, 16% (195 of 1240) of all patients undergoing TJA were transfused, whereas 6.5% (71 of 1092) were outside recommended AABB guidelines (hemoglobin ≥ 8 g/dL). In the 6 months after QI initiation, overall transfusions decreased to 6% (35 of 580) with 1.3% (seven of 538) having a hemoglobin ≥ 8 g/dL. The mean length of stay for nontransfused patients was shorter (2.4 days ± 0.9 versus 3.3 days ± 1.1, p < 0.001) and ischemic complications did not differ between groups (0.32% [four of 1240] versus 0.34% [two of 580], p = 0.61). Before and after education, neither the number of readmissions (5.4% [67 of 1240] versus 4.7% [27 of 580], p = 0.50) nor morbidity (3.6% [45 of 1240] versus 2.4% [14 of 580], p = 0.17) differed between time periods. There were no deaths. CONCLUSIONS Simple education and awareness of quality practices drive safety and compliance. The impact can be immediate and lasting. Arthroplasty registries that combine procedural and care quality data are vital and may be used for important data-driven QIs. LEVEL OF EVIDENCE Level III, therapeutic study.
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MESH Headings
- Aged
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/mortality
- Arthroplasty, Replacement, Hip/standards
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/mortality
- Arthroplasty, Replacement, Knee/standards
- Attitude of Health Personnel
- Awareness
- Blood Loss, Surgical/mortality
- Blood Loss, Surgical/prevention & control
- Blood Transfusion/mortality
- Blood Transfusion/standards
- Chi-Square Distribution
- Female
- Guideline Adherence
- Humans
- Length of Stay
- Linear Models
- Logistic Models
- Male
- Michigan
- Middle Aged
- Multivariate Analysis
- Odds Ratio
- Patient Discharge/standards
- Patient Readmission/standards
- Postoperative Hemorrhage/etiology
- Postoperative Hemorrhage/mortality
- Postoperative Hemorrhage/therapy
- Practice Guidelines as Topic/standards
- Practice Patterns, Physicians'/standards
- Quality Improvement/standards
- Quality Indicators, Health Care/standards
- Registries/standards
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Time Factors
- Transfusion Reaction
- Treatment Outcome
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Affiliation(s)
- David C Markel
- Providence Hospital and Medical Centers and The CORE Institute, 22250 Providence Drive, Suite #401, Southfield, MI, 48075, USA.
| | - Mark W Allen
- St John Macomb-Oakland Hospital, Oakland Center, Madison Heights, MI, USA
| | - Nicole M Zappa
- St John Macomb-Oakland Hospital, Oakland Center, Madison Heights, MI, USA
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Elmallah RK, Krebs VE, Mont MA. National and Hospital Registries: An Invaluable Source and Wealth of Information. J Arthroplasty 2015; 30:1673-5. [PMID: 25936558 DOI: 10.1016/j.arth.2015.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/16/2015] [Indexed: 02/01/2023] Open
Affiliation(s)
- Randa K Elmallah
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Viktor E Krebs
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, Ohio
| | - Michael A Mont
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, Ohio
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12
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Vardy J, Jenkins PJ, Clark K, Chekroud M, Begbie K, Anthony I, Rymaszewski LA, Ireland AJ. Effect of a redesigned fracture management pathway and 'virtual' fracture clinic on ED performance. BMJ Open 2014; 4:e005282. [PMID: 24928593 PMCID: PMC4067811 DOI: 10.1136/bmjopen-2014-005282] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Collaboration between the orthopaedic and emergency medicine (ED) services has resulted in standardised treatment pathways, leaflet supported discharge and a virtual fracture clinic review. Patients with minor, stable fractures are discharged with no further follow-up arranged. We aimed to examine the time taken to assess and treat these patients in the ED along with the rate of unplanned reattendance. DESIGN A retrospective study was undertaken that covered 1 year before the change and 1 year after. Prospectively collected administrative data from the electronic patient record system were analysed and compared before and after the change. SETTING An ED and orthopaedic unit, serving a population of 300 000, in a publicly funded health system. PARTICIPANTS 2840 patients treated with referral to a traditional fracture clinic and 3374 patients managed according to the newly redesigned protocol. OUTCOME MEASURES Time for assessment and treatment of patients with orthopaedic injuries not requiring immediate operative management, and 7-day unplanned reattendance. RESULTS Where plaster backslabs were replaced with removable splints, the consultation time was reduced. There was no change in treatment time for other injuries treated by the new discharge protocol. There was no increase in unplanned ED attendance, related to the injury, within 7 days (p=0.149). There was a decrease in patients reattending the ED due to a missed fracture clinic appointment. CONCLUSIONS This process did not require any new time resources from the ED staff. This process brought significant benefits to the ED as treatment pathways were agreed. The pathway reduced unnecessary reattendance of patients at face-to-face fracture clinics for a review of stable, self-limiting injuries.
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Affiliation(s)
- J Vardy
- Department of Emergency Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - P J Jenkins
- Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - K Clark
- Department of Emergency Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - M Chekroud
- Department of Emergency Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - K Begbie
- Department of Emergency Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - I Anthony
- Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - L A Rymaszewski
- Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - A J Ireland
- Department of Emergency Medicine, Glasgow Royal Infirmary, Glasgow, UK
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Development of appropriateness criteria for the surgical treatment of symptomatic lumbar degenerative spondylolisthesis (LDS). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:1903-17. [PMID: 24760463 DOI: 10.1007/s00586-014-3284-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 12/22/2013] [Accepted: 03/22/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Spine surgery rates are increasing worldwide. Treatment failures are often attributed to poor patient selection and inappropriate treatment, but for many spinal disorders there is little consensus on the precise indications for surgery. With an aging population, more patients with lumbar degenerative spondylolisthesis (LDS) will present for surgery. The aim of this study was to develop criteria for the appropriateness of surgery in symptomatic LDS. METHODS A systematic review was carried out to summarize the current level of evidence for the treatment of LDS. Clinical scenarios were generated comprising combinations of signs and symptoms in LDS and other relevant variables. Based on the systematic review and their own clinical experience, twelve multidisciplinary international experts rated each scenario on a 9-point scale (1 highly inappropriate, 9 highly appropriate) with respect to performing decompression only, fusion, and instrumented fusion. Surgery for each theoretical scenario was classified as appropriate, inappropriate, or uncertain based on the median ratings and disagreement in the ratings. RESULTS 744 hypothetical scenarios were generated; overall, surgery (of some type) was rated appropriate in 27%, uncertain in 41% and inappropriate in 31%. Frank panel disagreement was low (7% scenarios). Face validity was shown by the logical relationship between each variable's subcategories and the appropriateness ratings, e.g., no/mild disability had a mean appropriateness rating of 2.3 ± 1.5, whereas the rating for moderate disability was 5.0 ± 1.6 and for severe disability, 6.6 ± 1.6. Similarly, the average rating for no/minimal neurological abnormality was 2.3 ± 1.5, increasing to 4.3 ± 2.4 for moderate and 5.9 ± 1.7 for severe abnormality. The three variables most likely (p < 0.0001) to be components of scenarios rated "appropriate" were: severe disability, no yellow flags, and severe neurological deficit. CONCLUSION This is the first study to report criteria for determining candidacy for surgery in LDS developed by a multidisciplinary international panel using a validated method (RAM). The panel ratings followed logical clinical rationale, indicating good face validity. The work refines clinical classification and the phenotype of degenerative spondylolisthesis. The predictive validity of the criteria should be evaluated prospectively to examine whether patients treated "appropriately" have better clinical outcomes.
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Abstract
Comparative effectiveness research evaluates treatments as actually delivered in routine clinical practice, shifting research focus from efficacy and internal validity to effectiveness and external validity ("generalizability"). Such research requires accurate assessments of the numbers of patients treated and the completeness of their followup, their clinical outcomes, and the setting in which their care was delivered. Choosing measures and methods for clinical outcome research to produce meaningful information that may be used to improve patient care presents a number of challenges. WHERE ARE WE NOW?: Orthopaedic surgery research has many stakeholders, including patients, providers, payers, and policy makers. A major challenge in orthopaedic surgery outcome measurement and clinical research is providing all of these users with valid information for their respective decision making. At present, no plan exists for capturing data on such a broad scale and scope. WHERE DO WE NEED TO GO?: Practical challenges include identifying and obtaining resources for widespread data collection and merging multiple data sources. Challenges of study design include sampling to obtain representative data, timing of data collection in the episode of care, and minimizing missing data and study dropout. HOW DO WE GET THERE?: Resource limitations may be addressed by repurposing existing clinical resources and capitalizing on technologic advances to increase efficiencies. Increasing use of rigorous, well-designed observational research designs can provide information that may be unattainable in clinical trials. Such study designs should incorporate methods to minimize missing data, to sample multiple providers, facilities, and patients, and to include evaluation of potential confounding variables to minimize bias and allow generalization to broad populations.
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Zaidi R, Cro S, Gurusamy K, Sivanadarajah N, Macgregor A, Henricson A, Goldberg A. The outcome of total ankle replacement. Bone Joint J 2013; 95-B:1500-7. [DOI: 10.1302/0301-620x.95b11.31633] [Citation(s) in RCA: 204] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We performed a systematic review and meta-analysis of modern total ankle replacements (TARs) to determine the survivorship, outcome, complications, radiological findings and range of movement, in patients with end-stage osteoarthritis (OA) of the ankle who undergo this procedure. We used the methodology of the Cochrane Collaboration, which uses risk of bias profiling to assess the quality of papers in favour of a domain-based approach. Continuous outcome scores were pooled across studies using the generic inverse variance method and the random-effects model was used to incorporate clinical and methodological heterogeneity. We included 58 papers (7942 TARs) with an interobserver reliability (Kappa) for selection, performance, attrition, detection and reporting bias of between 0.83 and 0.98. The overall survivorship was 89% at ten years with an annual failure rate of 1.2% (95% confidence interval (CI) 0.7 to 1.6). The mean American Orthopaedic Foot and Ankle Society score changed from 40 (95% CI 36 to 43) pre-operatively to 80 (95% CI 76 to 84) at a mean follow-up of 8.2 years (7 to 10) (p < 0.01). Radiolucencies were identified in up to 23% of TARs after a mean of 4.4 years (2.3 to 9.6). The mean total range of movement improved from 23° (95% CI 19 to 26) to 34° (95% CI 26 to 41) (p = 0.01). Our study demonstrates that TAR has a positive impact on patients’ lives, with benefits lasting ten years, as judged by improvement in pain and function, as well as improved gait and increased range of movement. However, the quality of evidence is weak and fraught with biases and high quality randomised controlled trials are required to compare TAR with other forms of treatment such as fusion. Cite this article: Bone Joint J 2013;95-B:1500–7.
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Affiliation(s)
- R. Zaidi
- UCL Institute of Orthopaedics & Musculoskeletal Science, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, UK
| | - S. Cro
- UCL Institute of Orthopaedics & Musculoskeletal Science, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, UK
| | - K. Gurusamy
- University College London, Department
of Surgery, Royal Free Campus, Pond
Street, London NW3 2QG, UK
| | - N. Sivanadarajah
- UCL Institute of Orthopaedics & Musculoskeletal Science, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, UK
| | - A. Macgregor
- UCL Institute of Orthopaedics & Musculoskeletal Science, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, UK
| | - A. Henricson
- Falu Central Hospital, Department
of Orthopaedic Surgery, Falun, Sweden
| | - A. Goldberg
- UCL Institute of Orthopaedics & Musculoskeletal Science, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, UK
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Chahal J, Lee A, Heard W, Bach BR. A Retrospective Review of Anterior Cruciate Ligament Reconstruction Using Patellar Tendon: 25 Years of Experience. Orthop J Sports Med 2013; 1:2325967113501789. [PMID: 26535243 PMCID: PMC4555486 DOI: 10.1177/2325967113501789] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: The comparative data in the literature regarding rates of reoperation, revision ligament surgery, and contralateral surgery following anterior cruciate ligament reconstruction (ACLR) are variable and are often derived from studies with multiple surgeons, multiple centers, different surgical techniques, and a wide variety of graft choices. Purpose: To describe and analyze a single surgeon’s experience with ACLR using bone–patellar tendon–bone (BPTB) as the primary graft choice over a 25-year period. Study Design: Retrospective case series. Methods: All patients who underwent ACLR from 1986 to 2012 were identified from a prospectively maintained database. Traditional follow-up was only for patients who sought subsequent surgery with the index surgeon or presented with contralateral ACL injury. Covariates of interest included age, sex, time, and graft selection. Outcomes of interest included reoperation rates after primary/revision ACLR, rate of revision ACLR, success of meniscal repair with concomitant ACLR, and the proportion of patients undergoing contralateral surgery. Results: A total of 1981 patients (mean age, 29 years; 49% male) were identified. Of patients undergoing primary ACLR (n = 1809), 74% had BPTB autograft and 26% had a central third BPTB allograft. The mean age of patients undergoing autograft and allograft ACLR was 26 and 36 years, respectively (P < .05). Allograft tissue usage increased over time (P < .05). The rate of personal ACLR revision surgery was 1.7% (n = 30) for primary cases and 3.5% (n = 6) for revision cases. There were no significant differences in revision rates between primary autograft (1.6%) and allograft (2.0%) ACLR. With allograft use, the method of sterilization did not affect revision rates. The overall reoperation rate following primary ACLR was 10%; the 5-year reoperation rate was 7.7%. The reoperation rate was lower for primary cases reconstructed with allograft versus autograft (5% vs 12%) (P < .0001). Among primary ACLR cases, 332 patients (18%) underwent concomitant meniscal repair; 14% required revision meniscal surgery. The rate of contralateral ACLR was 6%. Conclusion: This information is useful for patients in the informed consent process, for perioperative decision making regarding graft choice, and for identifying patients who are at risk for injuring the uninvolved knee. The observed results in this series also emphasize that allograft ACLR can produce sustainable results with low complication rates in appropriately selected patients.
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Affiliation(s)
- Jaskarndip Chahal
- Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA. ; University of Toronto Sports Medicine Program, Women's College Hospital and Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Lee
- Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Wendell Heard
- Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA. ; Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Bernard R Bach
- Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
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Bjørgen S, Jessen V, Husby OS, Røset Ø, Foss OA. Internal quality register for joint prostheses. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:626-7. [PMID: 22456136 DOI: 10.4045/tidsskr.11.0852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Siri Bjørgen
- Orthopaedic Research Centre, St. Olavs Hospital and Department of Neuroscience, Norwegian University of Science and Technology, Norway.
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How reliable and accurate is the AO/OTA comprehensive classification for adult long-bone fractures? J Trauma Acute Care Surg 2012; 73:224-31. [DOI: 10.1097/ta.0b013e31824cf0ab] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Meling T, Harboe K, Arthursson AJ, Søreide K. Steppingstones to the implementation of an inhospital fracture and dislocation registry using the AO/OTA classification: compliance, completeness and commitment. Scand J Trauma Resusc Emerg Med 2010; 18:54. [PMID: 20955572 PMCID: PMC2976727 DOI: 10.1186/1757-7241-18-54] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 10/18/2010] [Indexed: 11/10/2022] Open
Abstract
Background Musculoskeletal trauma represents a considerable global health burden, however reliable population-based incidence data are scarce. A fracture and dislocation registry was established within a well-defined population. An audit of the establishment process, feasibility of the registry work and report of the collected data is given. Methods Demographic data, fracture type and location, mode of treatment, and the reasons for the secondary procedures were collected and scored using recognized systems, such as the AO/OTA classification and the Gustilo-Anderson classification for open fractures. The reporting was done in the operation planning program by the involved orthopaedic surgeon. Both inpatient and day-case procedures were collected. Data were collected prospectively from 2006 until 2010. Compliance among the surgeons and completeness and accuracy of the data was continuously assured by an orthopaedic surgeon. Results During the study period, 39 orthopaedic surgeons were involved in the recording of a total of 8,188 procedures, consisting of primary treatment of 4,986 long bone fractures, 467 non long bone fractures, 123 dislocations and 2,612 secondary treatments. In the study period 532 fractures or dislocations were treated at least once for one or more serious complications. For the index year of 2009, a total of 5710 fractures or dislocations were treated in the emergency department or hospitalized, of which the 1594 (28%) were treated at the inpatient or day-case operation rooms, thus registered in the FDR. Quality assurance, educational incentives and continuous feedback between coders and controller in the integrated electronic system are available and used through the features of the electronic database. Conclusions Implementing an integrated registry of fractures and dislocations with the electronic hospital system has been possible despite several users involved. The electronic system and the data controller provide for completeness and validity. The FDR has become an indispensable tool for the department for planning and education and will serve as a prerequisite for the conduct and execution of future prospective trials within the department. Further, other departments with similar electronic patient files may fairly easily adopt this system for implementation.
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Affiliation(s)
- Terje Meling
- Department of Orthopaedic Surgery, Stavanger University Hospital, Stavanger, Norway.
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The changing face of quality in spine surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 18 Suppl 3:277-8. [PMID: 19582486 DOI: 10.1007/s00586-009-1090-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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A comparison of outcomes of cervical disc arthroplasty and fusion in everyday clinical practice: surgical and methodological aspects. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 19:297-306. [PMID: 19882177 DOI: 10.1007/s00586-009-1194-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 08/27/2009] [Accepted: 10/12/2009] [Indexed: 10/20/2022]
Abstract
Randomised controlled trials (RCTs) of cervical disc arthroplasty vs fusion generally show slightly more favourable results for arthroplasty. However, RCTs in surgery often have limited external validity, since they involve a select group of patients who fit very rigid admission criteria and who are prepared to subject themselves to randomisation. The aim of this study was to examine whether the findings of RCTs are verified by observational data recorded in our Spine Center in association with the Spine Society of Europe Spine Tango surgical registry. Patients undergoing fusion/stabilisation or disc arthroplasty for degenerative cervical spinal disease were selected for inclusion. They completed a questionnaire pre-operatively and at 12 and 24 months follow-up (FU). The questionnaire comprised the multidimensional Core Outcome Measures Index (COMI; 0-10 scale) and, at FU, questions on global outcome and satisfaction with treatment (5-point scales, dichotomised to "good" and "poor"), re-operation and patient-rated complications. The surgeon completed a Spine Tango Surgery form. The outcome data from 266 (208 fusion, 58 arthroplasty) out of 284 eligible patients who had reached 12 months FU, and 169 (139 fusion, 30 arthroplasty) out of 178 who had reached 24 months FU, were included. Patients with cervical disc arthroplasty were younger [46 (SD 8) years vs 56 (SD 11) years for fusion; P < 0.05], had less comorbidity (P < 0.05), more often had only mono-segmental pathology (69% arthroplasty, 47% fusion) and only one type of degenerative pathology (69% arthroplasty, 46% fusion). Surgical complication rates were similar in each group (arthroplasty, 1.5%; fusion, 2.6%). The reduction in the COMI score was significantly greater in the arthroplasty group (at 12 months, 4.8 (SD 3.0) vs 3.7 (SD 2.9) points for fusion, and at 24 months 5.1 (SD 2.8) vs 3.8 (SD 2.9) points; each P < 0.05). In the arthroplasty group, a "good" global outcome was recorded in 90% patients (at 12 months) and 93% (at 24 months); in the fusion group the figures were 80 and 82%, respectively (group differences at each timepoint, P > 0.09). Satisfaction with treatment was similar in both groups (89-93%), at each timepoint. In multiple regression analysis, treatment group was of borderline significance as a unique predictor of the change in COMI at FU (P = 0.059 at 12 months, P = 0.055 at 24 months) in a model in which known confounders (age, comorbidity, number of affected levels) were controlled for. Being in the arthroplasty group was associated with an approximately 1-point greater reduction in the COMI score at FU. The results of this observational study appear to support those of the RCTs and suggest that, in patients with degenerative pathology of the cervical spine, disc arthroplasty is associated with a slightly better outcome than fusion. However, given the small size of the difference, its clinical relevance is questionable, especially in view of the a priori more favourable outcome expected in the arthroplasty group due to the more rigorous selection of patients.
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