Do patient-reported outcome scores better identify outlier surgical practice compared with revision rates for total knee arthroplasty?

IF 2.5 2区 医学 Q1 ORTHOPEDICS
Morgan C H Lingard, Christopher M A Frampton, Gary J Hooper
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引用次数: 0

Abstract

Background and purpose:  The New Zealand Joint Registry provides surgeon-level feedback on revision rate and Oxford scores for primary total knee replacement (TKR). Potential outliers are identified using revision rate. Using patient-reported outcome measures to identify outliers, alongside revision rate, could provide a more comprehensive understanding of surgeons' results. We aimed to evaluate using Oxford scores compared with revision rates to identify potential outliers.

Methods:  A registry-based prospective longitudinal cohort design was used. The association between surgeon mean Oxford score at 6 months and revision rate at 2 years, within 5 years, and within 10 years was evaluated using the Pearson correlation coefficient. Funnel and scatter plots were used to compare potential outliers for both measures using control limit and centile outlier thresholds respectively. All TKR in the registry prior to 31 December 2021, performed for any indication, were included.

Results:  There was a weak negative association between mean Oxford score at 6 months and revision rate at 2 years, within 5 years, and within 10 years using the Pearson correlation coefficient. Funnel plot control limits identified similar numbers of outliers for 6-month Oxford score and revision rate, however, there here was minimal overlap in outliers identified using the 2 methods. There was also minimal overlap in outliers using centile thresholds.

Conclusion:  Correlation between Oxford score at 6 months and revision rates is weaker at the surgeon level compared with the patient level. Mean Oxford score identifies different potential outliers compared with revision rates with minimal overlap. This has implications for reporting surgeon-level outcomes, raising questions regarding the most appropriate measure of surgical performance following TKR.

与全膝关节置换术的翻修率相比,患者报告的结果评分是否能更好地识别异常手术实践?
背景和目的:新西兰联合注册中心提供了初级全膝关节置换术(TKR)的翻修率和牛津评分的外科水平反馈。使用修正率来识别潜在的异常值。使用患者报告的结果测量来识别异常值,以及翻修率,可以更全面地了解外科医生的结果。我们的目的是使用牛津评分与修订率进行评估,以识别潜在的异常值。方法:采用基于注册表的前瞻性纵向队列设计。使用Pearson相关系数评估6个月时的外科医生平均牛津评分与2年、5年和10年内的翻修率之间的关系。漏斗图和散点图分别使用控制极限和百分位异常值阈值比较两种措施的潜在异常值。所有在2021年12月31日之前登记的TKR,包括任何适应症。结果:使用Pearson相关系数计算,6个月时的平均牛津评分与2年、5年和10年的复习率呈弱负相关。漏斗图控制极限确定了6个月牛津评分和修正率的异常值数量相似,然而,使用两种方法确定的异常值重叠最小。使用百分位阈值的异常值也有最小的重叠。结论:6个月时牛津评分与翻修率的相关性在外科水平较患者水平弱。平均牛津分数与最小重叠的修正率相比,确定了不同的潜在异常值。这对报告外科水平的结果有影响,提出了关于TKR后最合适的手术表现衡量标准的问题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Acta Orthopaedica
Acta Orthopaedica 医学-整形外科
CiteScore
6.40
自引率
8.10%
发文量
105
审稿时长
4-8 weeks
期刊介绍: Acta Orthopaedica (previously Acta Orthopaedica Scandinavica) presents original articles of basic research interest, as well as clinical studies in the field of orthopedics and related sub disciplines. Ever since the journal was founded in 1930, by a group of Scandinavian orthopedic surgeons, the journal has been published for an international audience. Acta Orthopaedica is owned by the Nordic Orthopaedic Federation and is the official publication of this federation.
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