Quality measures for total ankle replacement, 30-day readmission and reoperation rates within 1 year of surgery: a data linkage study using the NJR data set

Category: Ankle Introduction/Purpose: Intra and post-operative fractures are recognised complications of total ankle replacement (TAR) surgery. Intra-operative fractures are captured on the National Joint Registry (NJR) in the UK. The NJR has been capturing data on ankle replacement surgery since April 2010 and the number of TARs on the register is approaching 4000. Post-operative fractures are captured in the Hospital Episodes Statistics (HES) database. HES stores all patients admitted to NHS hospitals in England and captures 125 million records each year. Diagnostic information is stored using the International Classification of Diseases (ICD) and operative details using the Office of Population, Censuses and Surveys Classification (OPCS) codes. The purpose of this work was to determine the rate of intra and post-operative fracture with primary TAR and determine risk factors. Methods: A data-linkage study of the UK National Joint Registry (NJR) data and Hospital Episodes Statistics (HES) database was peformed using the first 3 years of NJR data. These two databases were linked in a deterministic fashion. 1522 NJR records were linked with the HES data set of over 90 million records. 1110 records were able to linked and available for analysis. Unlinked NJR data was analysed to identify intra-operative fractures. Linked data was analysed to identify post-operative fractures using ICD codes. Logistic regression was used to model predictors of intra and post-operative fractures. Every model was adjusted for patient characteristics including age, BMI, comorbidity and ASA grade. Results: The rate of intra-operative fracture was 2.69% (95% CI 2.67% to 2.74%). When looking at patient characteristics no significant predictors emerged. Logistic regression adjusted for patient characteristics showed that patients with rheumatoid arthritis were twice as likely to have a intra-operative fractures. The rate of post-operative fracture in the 12 months following primary TAR was 1.08% (95% CI 1.05% to 1.14%). Age emerged as a risk factor with a 5 five fold increase in risk of post-operative fracture with age 65-74 compared with those below 65. Adjusted logistic regression showed an increase risk of post-operative fracture in rheumatoid patients, hybrid operations and with those with multiple concurrent procedures. The risk of fracture was doubled with one associated procedure and tripled with two procedures. Conclusion: The rate of intra and post-operative fracture associated with primary total ankle replacement is low. However care should be taken with patients over 65 as they are at greater risk of intra operative fractures. Patients with rheumatoid arthritis are at greater risk of both, likely due to the effect of drug treatment. All efforts should be made to review medications and bone protective medication prescribed for these patents when undergoing TAR.

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Comprehensive investigation of congenital anomalies in cerebral palsy: protocol for a European-Australian population-based data linkage study (The Comprehensive CA-CP Study)

BMJ Open ◽

10.1136/bmjopen-2018-022190 ◽

2018 ◽

Vol 8 (7) ◽

pp. e022190 ◽

Cited By ~ 2

Author(s):

Shona Goldsmith ◽

Guiomar Garcia Jalon ◽

Nadia Badawi ◽

Eve Blair ◽

Ester Garne ◽

...

Keyword(s):

Congenital Anomaly ◽

Cerebral Palsy ◽

Congenital Anomalies ◽

Data Linkage ◽

Collaborative Study ◽

Population Based ◽

Linkage Study ◽

Data Set ◽

Effective Prevention ◽

Causal Pathways

IntroductionCerebral palsy (CP), an umbrella term for non-progressive conditions of cerebral origin resulting in motor impairments, is collectively the most common cause of physical disability in childhood. Cerebral and/or non-cerebral congenital anomalies are present in 15%–40% of children with CP. In order to identify effective prevention strategies for this substantial proportion of CP, a comprehensive understanding of the epidemiology of these congenital anomalies is required. International collaboration is needed, as previous attempts have fallen short due to a lack of power, since the anomalies are individually rare and CP comprises many clinical descriptions. The aim of this study is to generate new knowledge about the aetiologies of CP through a focused investigation into the role of congenital anomalies.Methods and analysisThis collaborative, population-based data linkage study includes nine geographic regions (six in Europe, three in Australia) served by both congenital anomaly and CP registers. Register data for children with CP (both with and without congenital anomalies) and children with specific congenital anomalies (without CP) born between 1991 and 2009 will be linked and de-identified within each region. The resulting linked data sets will be quality assured, recoded, harmonised and then pooled into one data set. Analysis of the combined data set will include: frequencies/proportions of congenital anomalies and outcomes (type of CP, severity, impairments); descriptive analyses comparing timing of congenital anomaly development and brain injury/abnormality responsible for CP; ORs to calculate the odds of CP following a specific congenital anomaly; and identification of anomalies on causal pathways to CP.Ethics and disseminationEthics approval for this collaborative study, The Comprehensive CA-CP Study, has been obtained from the Cerebral Palsy Alliance Human Research Ethics Committee (EC00402). Study findings will be disseminated at conferences and published in peer-reviewed journals, and recommendations will be made regarding the collection and classification of congenital anomaly data by CP registers.

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