Does early return to theatre add value to rates of revision at 3 years in assessing surgeon performance for elective hip and knee arthroplasty? National observational study
| Autor: | Mark Loeffler, Helen E Chase, Paul Aylin, Alex Bottle |
|---|---|
| Přispěvatelé: | Dr Foster Intelligence, Imperial College Healthcare NHS Trust, National Institute for Health Research (NIHR) |
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Reoperation medicine.medical_specialty Funnel plot Adolescent Joint replacement Arthroplasty Replacement Hip medicine.medical_treatment State Medicine Young Adult 03 medical and health sciences 0302 clinical medicine Power calculations Outcome Assessment Health Care Humans Medicine 030212 general & internal medicine Arthroplasty Replacement Knee Child Aged Quality Indicators Health Care Aged 80 and over 030222 orthopedics business.industry Health Policy General surgery Health services research Outcome measures Infant Orthopedic Surgeons performance measures Middle Aged Arthroplasty health services research Surgery Benchmarking England statistics Elective Surgical Procedures Child Preschool Female Observational study Metric (unit) business |
| Zdroj: | BMJ Quality & Safety. 27:373-379 |
| ISSN: | 2044-5423 2044-5415 |
| Popis: | BackgroundJoint replacement revision is the most widely used long-term outcome measure in elective hip and knee surgery. Return to theatre (RTT) has been proposed as an additional outcome measure, but how it compares with revision in its statistical performance is unknown.MethodsNational hospital administrative data for England were used to compare RTT at 90 days (RTT90) with revision rates within 3 years by surgeon. Standard power calculations were run for different scenarios. Funnel plots were used to count the number of surgeons with unusually high or low rates.ResultsFrom 2006 to 2011, there were 297 650 hip replacements (HRs) among 2952 surgeons and 341 226 knee replacements (KRs) among 2343 surgeons. RTT90 rates were 2.1% for HR and 1.5% for KR; 3-year revision rates were 2.1% for HR and 2.2% for KR. Statistical power to detect surgeons with poor performance on either metric was particularly low for surgeons performing 50 cases per year for the 5 years. The correlation between the risk-adjusted surgeon-level rates for the two outcomes was +0.51 for HR and +0.20 for KR, both pConclusionRTT90 appears to provide useful and complementary information on surgeon performance and should be considered alongside revision rates, but low case loads considerably reduce the power to detect unusual performance on either metric. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|