Variability of indication criteria in knee and hip replacement: an observational study
| Autor: | Antonio Escobar, Amaia Latorre, Cristina Sarasqueta, Carmen Herrera-Espiñeira, Lidia García, Raquel Cobos, J. I. Güenaga, Felipe Aizpuru |
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| Přispěvatelé: | [Cobos,R, Latorre,A, Aizpuru,F] Health Research Unit of Alava, Basque Health Service Vitoria-Gasteiz, Álava, Spain. [Guenaga,JI] Santiago Hospital, Vitoria-Gasteiz, Álava, Spain. [ Sarasqueta,C] Donostia Hospital,San Sebastian, Guipuzcoa, Spain.[Escobar,A] Basurto Hospital, Bilbao, Vizcaya, Spain.[García,L] Canary Islands Foundation for Health Research (FUNCIS), Santa Cruz de Tenerife, Canary Islands, Spain. [Herrera-Espiñeira,C] Virgen de las Nieves Hospital, Granada, Spain. [Aizpuru, F, Sarasqueta,C, Escobar,A, García,L] Network Center for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain.[Aizpuru,F] University of Basque Country (UPV/EHU), Spain., We are very grateful to funding sources: the Health Research Fund of Spanish Ministry of Health and Consumption (FIS project no 040938) and Health Department of the Government of the Basque Country. |
| Jazyk: | angličtina |
| Rok vydání: | 2010 |
| Předmět: |
Male
joint replacement lcsh:Diseases of the musculoskeletal system Sports medicine Pautas en la Práctica de los Médicos Arthroplasty Replacement Hip Health Status medicine.medical_treatment population Named Groups::Persons::Age Groups::Adult::Middle Aged [Medical Subject Headings] outcomes Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] Analytical Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures Operative::Prosthesis Implantation::Arthroplasty Replacement::Arthroplasty Replacement Hip [Medical Subject Headings] Mediana Edad Quality of life Hip replacement Prospective Studies Practice Patterns Physicians' Arthroplasty Replacement Knee Masculino Observer Variation Ontario education.field_of_study Femenino Variaciones Dependientes del Observador health ORTHOPEDICS AND SPORTS MEDICINE Estudios Prospectivos Middle Aged Humanos Artroplastia de Reemplazo de Rodilla gender differences Female Research Article medicine.medical_specialty Health Care::Environment and Public Health::Public Health::Epidemiologic Factors::Observer Variation [Medical Subject Headings] WOMAC Analytical Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Prospective Studies [Medical Subject Headings] Joint replacement Population Anciano Health Care::Health Care Quality Access and Evaluation::Delivery of Health Care::Physician's Practice Patterns [Medical Subject Headings] Check Tags::Male [Medical Subject Headings] Rheumatology orthopedic surgeons medicine Humans Named Groups::Persons::Age Groups::Adult::Aged [Medical Subject Headings] education Aged business.industry Disciplines and Occupations::Social Sciences::Demography::Health Status [Medical Subject Headings] Arthroplasty Analytical Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures Operative::Prosthesis Implantation::Arthroplasty Replacement::Arthroplasty Replacement Knee [Medical Subject Headings] osteoarthritis Check Tags::Female [Medical Subject Headings] quality of life Orthopedic surgery Physical therapy arthroplasty Artroplastia de Reemplazo de Cadera lcsh:RC925-935 business |
| Zdroj: | Addi. Archivo Digital para la Docencia y la Investigación instname BMC Musculoskeletal Disorders, Vol 11, Iss 1, p 249 (2010) BMC Musculoskeletal Disorders |
| Popis: | Background Total knee (TKR) and hip (THR) replacement (arthroplasty) are effective surgical procedures that relieve pain, improve patients' quality of life and increase functional capacity. Studies on variations in medical practice usually place the indications for performing these procedures to be highly variable, because surgeons appear to follow different criteria when recommending surgery in patients with different severity levels. We therefore proposed a study to evaluate inter-hospital variability in arthroplasty indication. Methods The pre-surgical condition of 1603 patients included was compared by their personal characteristics, clinical situation and self-perceived health status. Patients were asked to complete two health-related quality of life questionnaires: the generic SF-12 (Short Form) and the specific WOMAC (Western Ontario and Mcmaster Universities) scale. The type of patient undergoing primary arthroplasty was similar in the 15 different hospitals evaluated. The variability in baseline WOMAC score between hospitals in THR and TKR indication was described by range, mean and standard deviation (SD), mean and standard deviation weighted by the number of procedures at each hospital, high/low ratio or extremal quotient (EQ5-95), variation coefficient (CV5-95) and weighted variation coefficient (WCV5-95) for 5-95 percentile range. The variability in subjective and objective signs was evaluated using median, range and WCV5-95. The appropriateness of the procedures performed was calculated using a specific threshold proposed by Quintana et al for assessing pain and functional capacity. Results The variability expressed as WCV5-95 was very low, between 0.05 and 0.11 for all three dimensions on WOMAC scale for both types of procedure in all participating hospitals. The variability in the physical and mental SF-12 components was very low for both types of procedure (0.08 and 0.07 for hip and 0.03 and 0.07 for knee surgery patients). However, a moderate-high variability was detected in subjective-objective signs. Among all the surgeries performed, approximately a quarter of them could be considered to be inappropriate. Conclusions A greater inter-hospital variability was observed for objective than for subjective signs for both procedures, suggesting that the differences in clinical criteria followed by surgeons when indicating arthroplasty are the main responsible factors for the variation in surgery rates. |
| Databáze: | OpenAIRE |
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