Hospital variation in allogeneic transfusion and extended length of stay in primary elective hip and knee arthroplasty: a cross-sectional study

Voorn, Veronique M A; Mheen, Perla J Marang-van de; Hout, Anja van der; So‐Osman, Cynthia; Marle, M.E. van den Akker-van; Gemert, A.W.M.M. Koopman-van; Dahan, Albert; Vlieland, Thea Vliet; Nelissen, Rob G H H; Bodegom‐Vos, Leti van

doi:10.1136/bmjopen-2016-014143

Cited by 5 publications

(9 citation statements)

References 48 publications

(24 reference statements)

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“…It must be noted that LOS for unilateral procedures during the same time interval in our hospital was 5.1 days, which is significantly lower than for bilateral procedures. This finding is consistent with the literature [12, 27]. The strength of the study is the prospective documentation of outcomes, alongside the low rate of attrition.…”

Section: Discussionsupporting

confidence: 91%

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Sequential Bilateral Total Hip Arthroplasty Through a Minimally Invasive Anterior Approach is Safe to Perform

Petridis¹,

Nolde²

2017

TOORTHJ

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Background:Sequential bilateral total hip arthroplasty (THA) has the potential advantages of a single operative intervention with a single hospital stay, alongside reduced costs and total rehabilitation times. Its use has been limited, however, by a theoretical increase in perioperative complications.Objective:The purpose of this study was to assess functional outcomes and complications in patients undergoing sequential bilateral THA performed using anterior minimally invasive surgery (AMIS). We hypothesized that sequential bilateral THA yields favorable clinical outcome and is safe to perform.Methods:Two surgical centres conducted a retrospective observational analysis of 130 patients (77 females) with a mean age of 57 (range, 35-77) years, all of whom were treated by one surgeon and followed up for 24 months.Results:The mean length of hospital stay length was 8.4 (range, 6–18) days. The mean operative time was 162 (range, 92–185) minutes, the mean intraoperative blood loss was 499.1ml, and the mean preoperative and postoperative hemoglobin levels were 14.3 g/dl and 11.3 g/dl, respectively. No perioperative complications or deaths were recorded. The Harris Hip Score (HHS) improved from 44.5 ±13.7 preoperatively to 98.9 ± 1.0 at final follow-up. Also the High Activity Arthroplasty Score (HAAS) and the Questions on Life Satisfaction (FLZ) score improved significantly.Conclusion:This retrospective analysis suggests that, in selected patients, sequential bilateral THA via an anterior minimally invasive approach appears to be a valid alternative to two-stage bilateral THA. Further studies are warranted.

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Section: Discussionsupporting

confidence: 91%

“…Most of the studies reported increases in homologous blood transfusion rates of 20% to 40% after sequential THA [24]. The mean LOS found in the present study was 7.6 days, which is above the average as reported in the literature [25-27]. Germany has globally one of the longest duration of stay in the hospital.…”

Section: Discussionsupporting

confidence: 41%

Sequential Bilateral Total Hip Arthroplasty Through a Minimally Invasive Anterior Approach is Safe to Perform

Petridis¹,

Nolde²

2017

TOORTHJ

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“…From the 20 studies reporting complication rates, the between-hospital variation was reported in 11 studies (5 MQ, 6 LQ) for THA (9,10,21,27,41,42,43,44,45,46,47), 8 studies (4 MQ, 4 LQ) for TKA (10,21,33,44,45,46,47,48) and 8 studies (1 HQ, 3 MQ, 4 LQ) for THA and TKA combined (14,15,16,32,38,47,49,50). Eight studies reported the variation more than once with different outcome definition, follow-up, and type of hospitals selected (Table 5).…”

Section: Complicationsmentioning

confidence: 99%

“…Most registries give feedback through annual reports intended to encourage quality improvement initiatives in lowwww.efortopenreviews.org 7:4 A systematic review including 33 studies and 8 arthroplasty register reports performing hospitals and learn from high-performing hospitals by adopting best practices (1,2,3,4,5,6,7,8). In addition, scientific articles are published for quality improvement purposes; for example, hospitals are benchmarked, ranked, or (statistical) methods are compared to monitor the quality of care delivered (9,10,11,12,13). The most commonly used quality indicators in this context are implant revision, readmission, and complications, as these indicators are considered reliable, actionable, and fit for purpose (14,15,16,17,18,19).…”

Section: Introductionmentioning

confidence: 99%

International comparison of variation in performance between hospitals for THA and TKA: Is it even possible? A systematic review including 33 studies and 8 arthroplasty register reports

et al. 2022

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In order to improve care for total hip and knee arthroplasties (THA/TKA), hospitals may want to compare their performance with hospitals in other countries. Pooling data across countries also enable early detection of infrequently occurring safety issues. We therefore aimed to assess the between-hospital variation and definitions used for revision, readmission, and complications across countries. PubMed, Embase, Web of Science, Cochrane library, Emcare, and Academic Search Premier were searched from January 2009 to August 2020 for studies reporting on: (i) primary THA/TKA; (ii) revision, readmission, or complications; and (iii) between-hospital variation. Most recent registry reports of Network of Orthopedic Registries of Europe members were also reviewed. Two reviewers independently screened records, extracted data, and assessed the risk of bias using the Integrated quality Criteria for the Review Of Multiple Study designs tool for studies and relevant domains for registries. We assessed agreement for the following domains: (i) outcome definition; (ii) follow-up and starting point; (iii) case-mix adjustment; and (iv) type of patients and hospitals included. Between-hospital variation was reported in 33 (1 high-quality, 13 moderate-quality, and 19 low-quality) studies and 8 registry reports. The range of variation for revision was 0–33% for THA and 0–27% for TKA varying between assessment within hospital admission until 10 years of follow-up; for readmission, 0–40% and 0–32% for THA and TKA, respectively; and for complications, 0–75% and 0–50% for THA and TKA, respectively. Indicator definitions and methodological variables varied considerably across domains. The large heterogeneity in definitions and methods used likely explains the considerable variation in between-hospital variation reported for revision, readmission, and complications , making it impossible to benchmark hospitals across countries or pool data for earlier detection of safety issues. It is necessary to collaborate internationally and strive for more uniformity in indicator definitions and methods in order to achieve reliable international benchmarking in the future.

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“…A similar concept is referred to as ‘statistical reliability’ by others [13]. This concept has been implemented for both diagnostic and process indicators [14], as well as for outcome indicators in different fields [15–18].…”

Section: Introductionmentioning

confidence: 99%

Ranking hospital performance based on individual indicators: can we increase reliability by creating composite indicators?

Austin¹,

Ceyisakar

Lingsma

et al. 2019

BMC Med Res Methodol

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Background Report cards on the health care system increasingly report provider-specific performance on indicators that measure the quality of health care delivered. A natural reaction to the publishing of hospital-specific performance on a given indicator is to create ‘league tables’ that rank hospitals according to their performance. However, many indicators have been shown to have low to moderate rankability, meaning that they cannot be used to accurately rank hospitals. Our objective was to define conditions for improving the ability to rank hospitals by combining several binary indicators with low to moderate rankability. Methods Monte Carlo simulations to examine the rankability of composite ordinal indicators created by pooling three binary indicators with low to moderate rankability. We considered scenarios in which the prevalences of the three binary indicators were 0.05, 0.10, and 0.25 and the within-hospital correlation between these indicators varied between − 0.25 and 0.90. Results Creation of an ordinal indicator with high rankability was possible when the three component binary indicators were strongly correlated with one another (the within-hospital correlation in indicators was at least 0.5). When the binary indicators were independent or weakly correlated with one another (the within-hospital correlation in indicators was less than 0.5), the rankability of the composite ordinal indicator was often less than at least one of its binary components. The rankability of the composite indicator was most affected by the rankability of the most prevalent indicator and the magnitude of the within-hospital correlation between the indicators. Conclusions Pooling highly-correlated binary indicators can result in a composite ordinal indicator with high rankability. Otherwise, the composite ordinal indicator may have lower rankability than some of its constituent components. It is recommended that binary indicators be combined to increase rankability only if they represent the same concept of quality of care.

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Hospital variation in allogeneic transfusion and extended length of stay in primary elective hip and knee arthroplasty: a cross-sectional study

Cited by 5 publications

References 48 publications

Sequential Bilateral Total Hip Arthroplasty Through a Minimally Invasive Anterior Approach is Safe to Perform

Sequential Bilateral Total Hip Arthroplasty Through a Minimally Invasive Anterior Approach is Safe to Perform

International comparison of variation in performance between hospitals for THA and TKA: Is it even possible? A systematic review including 33 studies and 8 arthroplasty register reports

Ranking hospital performance based on individual indicators: can we increase reliability by creating composite indicators?

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