Influence of Revision Surgeries and Revision Rate on Quality Indicators in Certified Centres for Joint Replacement (EndoProthetikZentren)

Abstract

Background The annual report of EndoCert publishes the results of the quality indicators (QI) and key figures of all certified centres for joint replacement (EndoProthetikZentren – EPZ). For some results it seems that centres with fewer revisions might have higher complication rates. However, to avoid misinterpretation the results have to be evaluated in more detail. The influence of the quantity of the revisions or the revision quotient on the quality of outcome was investigated.

Material and Methods This study included all certified EPZ and centres of excellence for joint replacement (EPXmax) (n = 492) and evaluated the data from 2016. Centres beyond the action limit were identified with the help of funnel plots and a confidence limit of 99.7% as action limit. Additionally data of the quality indicators were analysed with ANCOVA. The level of significance was p < 0.05.

Results The comparison by ANCOVA with number of revisions as co-variate showed no differences in the complication rates when related to the quantity of revisions. When considering a so called revision quotient (ratio of revision to all joint replacements) significant differences in the rate of fractures and fissures as well as in mortality for hip replacements and also in mortality for knee replacements were observed.

Conclusion EPZ with fewer revisions do not have higher complication rates than centers with high numbers of revisions. Thus, the quantity of revisions has no influence on the quality of the outcome, considering that on the basis of the data of the EndoCert system no risk adjustment of patient-specific data was performed. Therefore the revisioin quotient of an EPZ shows that quantity is not equal with quality.

Key words

EndoCert - quality indicators - quality of outcome - revision quotient - complication rate

Publikationsverlauf

Artikel online veröffentlicht:
25. Februar 2020

• References/Literatur

• 1 Haas H, Grifka J, Günter KP, Heller KD, Niethard FU, Windhagen H, Ebner M, Mittelmaier W. Hrsg. EndoCert^®: Zertifizierung von Endoprothetischen Versorgungszentren in Deutschland. Eine Initiative der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC) mit Unterstützung der Arbeitsgemeinschaft Endoprothetik (AE) in der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie (DGOU) und des Berufsverbandes der Fachärzte für Orthopädie und Unfallchirurgie (BVOU). Stuttgart: Thieme; 2013
• 2 Haas H, Bail H, Günther K. et al. Anforderungskatalog für EndoProthetikZentren zur Zertifizierung von EndoProthetikZentren als qualitätssichernde Maßnahme in der Behandlung von Gelenkerkrankungen: EndoProthetikZentrum (EndoCert) (EPZ).
• 3 Haas H, Bail H, Günther K. et al. Anforderungskatalog für EndoProthetikZentren zur Zertifizierung von EndoProthetikZentren als qualitätssichernde Maßnahme in der Behandlung von Gelenkerkrankungen: EndoProthetikZentrum der Maximalversorgung (EndoCert) (EPZmax). DOI: 10.1055/B-9783131740816-00001.
• 4 Mittelmeier W, Bail H, Günther K. et al. EndoCert-Jahresbericht 2017: Zertifizierte EndoProthetikZentren gemäß EndoCert (25.08.2017).
• 5 Mittelmeier W, Bail H, Günther K. et al. EndoCert-Jahresbericht 2018: Zertifizierte EndoProthetikZentren gemäß EndoCert (27.04.2018).
• 6 Spiegelhalter DJ. Funnel plots for comparing institutional performance. Stat Med 2005; 24: 1185-1202
• 7 Manktelow BN, Seaton SE. Specifying the probability characteristics of funnel plot control limits: an investigation of three approaches. PLoS One 2012; 7: e45723
• 8 Manktelow BN, Seaton SE, Evans TA. Funnel plot control limits to identify poorly performing healthcare providers when there is uncertainty in the value of the benchmark. Stat Methods Med Res 2016; 25: 2670-2684
• 9 van Dishoeck AM, Koek MBG, Steyerberg EW. et al. Use of surgical-site infection rates to rank hospital performance across several types of surgery. Br J Surg 2013; 100: 628-636
• 10 [Anonymous] How to draw a funnel plot in Microsoft Excel. “… a graphical aid for institutional comparisons …”. Im Internet (Stand: 12.092018): http://www.kurtosis.co.uk/technique/funnel_plot.htm
• 11 Packard GC, Boardman TJ. The use of percentages and size-specific indices to normalize physiological data for variation in body size: Wasted time, wasted effort?. Comp Biochem Physiol A Mol Integr Physiol 1999; 122: 37-44
• 12 Laucis NC, Chowdhury M, Dasgupta A. et al. Trend toward high-volume hospitals and the influence on complications in knee and hip arthroplasty. J Bone Joint Surg Am 2016; 98: 707-712
• 13 Maceroli M, Nikkel LE, Mahmood B. et al. Total hip arthroplasty for femoral neck fractures: improved outcomes with higher hospital volumes. J Orthop Trauma 2016; 30: 597-604
• 14 Becker A, Stausberg J, Fischer B. et al. Risikoadjustierung von Qualitätsindikatoren: Eine Positionsbestimmung der DKG-Expertengruppe „Qualitätsmessung und Risikoadjustierung“. Das Krankenhaus 2016; (11) 954-963
• 15 Fischer C, Lingsma HF, Anema HA. et al. Testing the construct validity of hospital care quality indicators: a case study on hip replacement. BMC Health Serv Res 2016; 16: 551
• 16 Graves S, de Steiger R, Lewis P. et al. National Joint Replacement Registry, hip, knee & shoulder arthroplasty: Annual Report 2018. Im Internet (Stand: 11.12.2018): http://aoanjrr.sahmri.com/annual-reports-2018
• 17 Porter M, Howard P, Lawrence S. et al. National Joint Registry for England, Wales, Northern Ireland and the Isle of Man: 15th Annual Report 2018. Im Internet (Stand: 11.12.2018): http://www.njrcentre.org.uk/njrcentre/Reports-Publications-and-Minutes/Annual-reports