Provision of revision knee surgery and calculation of the effect of a network service reconfiguration: An analysis from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man.

Autor: Kalson NS; Revision Knee Working Group, British Association for Surgery of the Knee, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, LondonWC2A 3PE, United Kingdom of Great Britain and Northern Ireland., Mathews JA; Revision Knee Working Group, British Association for Surgery of the Knee, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, LondonWC2A 3PE, United Kingdom of Great Britain and Northern Ireland., Miles J; Revision Knee Working Group, British Association for Surgery of the Knee, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, LondonWC2A 3PE, United Kingdom of Great Britain and Northern Ireland., Bloch BV; Revision Knee Working Group, British Association for Surgery of the Knee, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, LondonWC2A 3PE, United Kingdom of Great Britain and Northern Ireland., Price AJ; Revision Knee Working Group, British Association for Surgery of the Knee, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, LondonWC2A 3PE, United Kingdom of Great Britain and Northern Ireland., Phillips JRA; Revision Knee Working Group, British Association for Surgery of the Knee, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, LondonWC2A 3PE, United Kingdom of Great Britain and Northern Ireland., Toms AD; Revision Knee Working Group, British Association for Surgery of the Knee, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, LondonWC2A 3PE, United Kingdom of Great Britain and Northern Ireland., Baker PN; Revision Knee Working Group, British Association for Surgery of the Knee, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, LondonWC2A 3PE, United Kingdom of Great Britain and Northern Ireland. Electronic address: Paul.baker1@nhs.net.
Jazyk: angličtina
Zdroj: The Knee [Knee] 2020 Oct; Vol. 27 (5), pp. 1593-1600. Date of Electronic Publication: 2020 Sep 09.
DOI: 10.1016/j.knee.2020.07.094
Abstrakt: Background: Revision knee replacement (KR) is technically challenging, expensive, and outcomes can be poor. It is well established that increasing surgeon and unit volumes results in improved outcomes and cost-effectiveness for complex procedures. The aim of this study was to 1) describe the current provision of revision KR in England, Wales and Northern Ireland at the individual surgeon and unit level and 2) investigate the effect on workload of case distribution in a network model.
Methods: Current practice was mapped using NJR summary statistics containing all revision KR procedures performed over a three-year period (2016-2018). Units were identified as revision centres based on threshold volumes. Units undertaking <20 revisions per year were classified as Primary Arthroplasty Units (PAUs) in calculations on the effect of workload centralisation.
Results: Revision KR was performed by 1353 surgeons at 232 NHS sites. The majority of surgeons and units were low-volume; >1000 surgeons performed <7 and 125 sites performed <20 procedures per year. Reallocation of work from these 125 PAUs (1235 cases, 21% of total workload) to a network model with even redistribution of cases between centres undertaking revision surgery would result in an additional average annual case increase of 11 per unit per year (range six to 14).
Conclusions: Revision KR workload re-allocation would lift all revision centres above a 30 per year threshold and would appear to be a manageable increase in workload for specialist revision KR centres. Case complexity and local referral agreements will significantly affect the real increase in workload; these factors were not incorporated here.
Competing Interests: Declaration of competing interest None.
(Copyright © 2020. Published by Elsevier B.V.)
Databáze: MEDLINE
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