Artroplastias primarias de cadera implantadas en Cataluña: ¿qué evidencia clínica respalda a nuestras prótesis? / Primary total hip arthroplasty in Catalonia: What is the clinical evidence that supports our prosthesis?

Introducción: la cumplimentación de registros sobre la implantación de prótesis permite obtener una gran cantidad de datos y extraer conclusiones que redundan en la mejora de la utilización de las mismas. Suecia fue el primer país en implantar un sistema de registro de artroplastias en 1979. Cataluña lo viene haciendo desde el año 2005. El objetivo de nuestro trabajo es analizar la evidencia que respalda a las prótesis implantadas en artroplastias totales de cadera primarias en Cataluña en los últimos 9 años sobre la base del Registro de Artroplastias de Cataluña (RACat). Material y métodos: se realizó una revisión en la literatura de las prótesis (cotilos/vástagos) registrados en el RACat entre los años 2005-2013 en las siguientes bases datos: Orthopaedic Data Evaluation Panel (ODEP), Tripdatabase, Pubmed, Google académico. Se excluyeron aquellas prótesis implantadas en número inferior a 10 unidades (182 cotilos correspondientes a 49 modelos/228 vástagos correspondientes a 63 modelos). Resultados: de los 18.816 cotilos implantados, se analizaron 18.634 (el 99%), correspondientes a 74 modelos diferentes. En 18 modelos (2.527 cotilos) no se encontraron evidencias clínicas que respalden su uso. De los 19.595 vástagos implantados se analizaron 19.367 (el 98,84%), correspondientes a 75 modelos diferentes. En 16 modelos (1.845 vástagos) no se encontraron evidencias clínicas que respalden su uso. En los 56 modelos de cotilos (16.107) y los 59 modelos de vástagos (17.522) restantes las evidencias variaron en función del número de pacientes y los años de seguimiento, predominando los estudios con nivel de evidencia iv. Conclusiones: existe un número significativo de prótesis implantadas evaluadas (13,56% cotilos/9,5% vástagos) en los que no se han encontrado evidencias clínicas. Cabe destacar el alto número de modelos (49 tipos para cotilos/63 tipos para vástagos) con una implantación inferior a 10 unidades que corresponden únicamente al 1% del total. La implantación de registros de artroplastias se revela como una herramienta extremadamente útil al permitirnos analizar y extraer conclusiones para la evaluación y el seguimiento poscomercialización

Introduction: the implementation of National Prostheses Registries allows us to obtain a large amount of data and make conclusions in order to improve the use of them. Sweden was the first country to implement a National Prostheses Registry in 1979. Catalonia has been doing this since 2005. The aim of our study is to analyse the evidence that supports primary total hip replacement in Catalonia in the last 9 years, based on the Arthroplasty Registry of Catalonia (RACat). Material and methods: a review of the literature was carried out of the prosthesis (acetabular cups/stems) reported in the RACat between the period 2005 to 2013 in the following databases: ODEP (Orthopaedic Data Evaluation Panel), TRIP database, PubMed, and Google Scholar. Those prostheses implanted in less than 10 units (182 acetabular components corresponding to 49 models/228 stems corresponding to 63 models) were excluded. Results: a total of 18,634 (99%) implanted acetabular cups were analysed out of a total number of 18,816, corresponding to 74 different models. In 18 models (2527 acetabular cups) no clinical evidence to support its use was found. An analysis was performed on 19,367 (98.84%) out of a total number of 19,595 implanted stems, corresponding to 75 different models. In 16 models (1845 stems) no clinical evidence was found to support their use. Variable evidence was found in the 56 models of acetabular cups (16,107) and 59 models of stems (17,522), most of it corresponding to level iv clinical evidence. Conclusions: there was a significant number implanted prostheses evaluated (13.56% acetabular cups/9.5% stems) for which no clinical evidence was found. The elevated number of models is highlighted (49 types for acetabular cups/63 types for stems) with less than 10 units implanted, which corresponds to only 1% of the total implants. The use of arthroplasty registers is shown to be an extremely helpful tool that allows analyses and conclusions to be made for the follow-up and post-marketing surveillance period

Una década del Registro de Artroplastias de Cataluña (RACat): exhaustividad, variabilidad y supervivencia de las prótesis entre 2005 y 2014 / A decade of the Catalonian Arthroplasty Register (RACat): variability, exhaustivity, and survival of prostheses between 2005 and 2014

Antecedentes y objetivo. El Registro de Artroplastias de Cataluña (RACat) es un registro poblacional basado en el sistema sanitario público para analizar y evaluar artroplastias de cadera y rodilla en Cataluña. El objetivo de este estudio es presentar los resultados tras 10 años de funcionamiento (de enero de 2005 a diciembre de 2014). Metodología. A partir de la información del RACat y del conjunto mínimo básico de datos al alta hospitalaria, se analizó la calidad y exhaustividad de los datos y se realizaron análisis descriptivos de pacientes, prótesis y proceso asistencial. Además, se analizó la supervivencia calculando la incidencia acumulada de revisión (según causa de intervención en artroplastias de cadera y preservación o sacrificio del ligamento cruzado posterior en artroplastia de rodilla) y la asociación entre riesgo de revisión y técnica de fijación de las prótesis como modelos de riesgos competitivos ajustados por sexo, edad y comorbilidad. Resultados. El principal motivo de intervención en artroplastias primarias de cadera y rodilla fue la artrosis. La incidencia acumulada de revisión a los 10 años fue del 3,9% en artroplastias de cadera causadas por artrosis y del 2,3% en las causadas por fractura. Las artroplastias de rodilla que conservan el ligamento cruzado posterior son el 4,4% y las que no lo conservan, el 5,1%. Discusión. El RACat se consolida como herramienta para la evaluación de las artroplastias con gran potencial en el análisis de la efectividad a medio y largo plazo, el estudio de la variabilidad de la práctica clínica y la vigilancia poscomercialización (AU)

Background and aim. The Catalonian Arthroplasty Register (RACat) is a public health-based population register used to analyse and evaluate hip and knee replacements in Catalonia. The aim of this study is to present the outcomes after 10 years in operation (January 2005-December 2014). Methodology. Using the information from the RACat and the minimum basic data set at hospital discharge, an analysis was made of the quality and exhaustivity of the data, as well as a descriptive analysis of the patients, prostheses, and care process. Survival was also analysed by calculating the accumulated incidence of revisions (according to the cause of intervention in hip replacements and conservation or sacrifice of the posterior cruciate ligament in knee replacement). The relationship between revision risk and the fixation technique of the prosthesis is also analysed, using competitive risk models adjusted for gender, age, and comorbidities. Results. The main reason for the primary hip and knee replacement surgery was arthrosis. The accumulated incidence of revisions at 10 years was 3.9% in hip replacements caused by arthrosis, and 2.3% in those caused by fracture. Conservation of the posterior cruciate ligament was achieved in 4.4% of knee replacements, with sacrifice in 5.1%. Discussion. The RACat is consolidated as a tool for the evaluation of joint replacements, with great potential in the analysis of medium and long-term efficacy, the study of the variability in clinical practice, and post-marketing surveillance (AU)

A decade of the Catalonian Arthroplasty Register (RACat): Variability, exhaustivity, and survival of prostheses between 2005 and 2014. / Una década del Registro de Artroplastias de Cataluña (RACat): exhaustividad, variabilidad y supervivencia de las prótesis entre 2005 y 2014.

BACKGROUND AND AIM: The Catalonian Arthroplasty Register (RACat) is a public health-based population register used to analyse and evaluate hip and knee replacements in Catalonia. The aim of this study is to present the outcomes after 10 years in operation (January 2005-December 2014). METHODOLOGY: Using the information from the RACat and the minimum basic data set at hospital discharge, an analysis was made of the quality and exhaustivity of the data, as well as a descriptive analysis of the patients, prostheses, and care process. Survival was also analysed by calculating the accumulated incidence of revisions (according to the cause of intervention in hip replacements and conservation or sacrifice of the posterior cruciate ligament in knee replacement). The relationship between revision risk and the fixation technique of the prosthesis is also analysed, using competitive risk models adjusted for gender, age, and comorbidities. RESULTS: The main reason for the primary hip and knee replacement surgery was arthrosis. The accumulated incidence of revisions at 10 years was 3.9% in hip replacements caused by arthrosis, and 2.3% in those caused by fracture. Conservation of the posterior cruciate ligament was achieved in 4.4% of knee replacements, with sacrifice in 5.1%. DISCUSSION: The RACat is consolidated as a tool for the evaluation of joint replacements, with great potential in the analysis of medium and long-term efficacy, the study of the variability in clinical practice, and post-marketing surveillance.

Primary total hip arthroplasty in Catalonia: What is the clinical evidence that supports our prosthesis? / Artroplastias primarias de cadera implantadas en Cataluña: ¿qué evidencia clínica respalda a nuestras prótesis?

INTRODUCTION: The implementation of National Prostheses Registries allows us to obtain a large amount of data and make conclusions in order to improve the use of them. Sweden was the first country to implement a National Prostheses Registry in 1979. Catalonia has been doing this since 2005. The aim of our study is to analyse the evidence that supports primary total hip replacement in Catalonia in the last 9 years, based on the Arthroplasty Registry of Catalonia (RACat). MATERIAL AND METHODS: A review of the literature was carried out of the prosthesis (acetabular cups/stems) reported in the RACat between the period 2005 to 2013 in the following databases: ODEP (Orthopaedic Data Evaluation Panel), TRIP database, PubMed, and Google Scholar. Those prostheses implanted in less than 10 units (182 acetabular components corresponding to 49 models/228 stems corresponding to 63 models) were excluded. RESULTS: A total of 18,634 (99%) implanted acetabular cups were analysed out of a total number of 18,816, corresponding to 74 different models. In 18 models (2527 acetabular cups) no clinical evidence to support its use was found. An analysis was performed on 19,367 (98.84%) out of a total number of 19,595 implanted stems, corresponding to 75 different models. In 16 models (1845 stems) no clinical evidence was found to support their use. Variable evidence was found in the 56 models of acetabular cups (16,107) and 59 models of stems (17,522), most of it corresponding to level iv clinical evidence. CONCLUSIONS: There was a significant number implanted prostheses evaluated (13.56% acetabular cups/9.5% stems) for which no clinical evidence was found. The elevated number of models is highlighted (49 types for acetabular cups/63 types for stems) with less than 10 units implanted, which corresponds to only 1% of the total implants. The use of arthroplasty registers is shown to be an extremely helpful tool that allows analyses and conclusions to be made for the follow-up and post-marketing surveillance period.

Respuesta a la carta «El registro español de artroplastias» de los Dres. M. Fernández Fairén, R. Llopis y A. Rodríguez / Response to the letter «Spanish arthoplasty register» from M. Fernández Fairén, R. Llopis and A. Rodríguez

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Factores relacionados con la calidad de vida al año de la artroplastia total de cadera y rodilla: estudio multicéntrico en Cataluña / Quality of life-associated factors at one year after total hip and knee replacement: a multicentre study in Catalonia

Objetivo. Evaluar la calidad de vida relacionada con la salud (CVRS) de los pacientes antes y después de su artroplastia total de rodilla (ATR) y cadera (ATC), y los factores relacionados al año. Metodología. Estudio prospectivo cuasi-experimental. Se seleccionaron hospitales de diferente nivel de complejidad y volumen en Cataluña y los pacientes con indicación de ATC o ATR. Se administraron el SF-36 y el WOMAC, variables demográficas, psicosociales y una pregunta sobre percepción de cambio a los pacientes por entrevista telefónica. Se calcularon las diferencias estandarizadas en las puntuaciones del SF-36 y WOMAC antes y después de la cirugía (tamaños del efecto [TE]) según percepción de cambio. Se analizaron los factores relacionados con la CVRS al año, a partir de modelos lineales generales ajustados. Resultados. A pesar de que a nivel global, los pacientes (n = 672) presentaron mejoría en la mayoría de dimensiones de CVRS, un 9% percibió poca mejoría al año, siendo sus puntuaciones muy parecidas en el basal y seguimiento (TE pequeñas: 0,0-0,4). Las mujeres, pacientes con bajo apoyo social, con puntuaciones más bajas (peores) en la salud mental percibida y CVRS basal, y que declaran que su enfermedad es más grave, percibieron peor CVRS al año (p < 0,05). Conclusiones. Se han identificado los factores relacionados con el peor pronóstico de la artroplastia consistentes con otros estudios publicados. La valoración de la CVRS puede ser un instrumento clave para identificar casos de posible no mejoría, y poder valorar las alternativas o aplicar alguna intervención previa y mejorar así la eficiencia del proceso asistencial(AU)

Aims. To assess the health related quality of life (HRQOL) and associated factors of patients before, and one year after, total knee (TKA) and hip (THA) arthroplasty. Methods. A quasi-experimental prospective study conducted in hospitals with different levels of complexity and volume in Catalonia, and on patients with an indication of a TKA or THA. Demographic and psychosocial variables were recorded, and the SF-36 and WOMAC, and a question on perception of change after surgery were administered to patients by telephone interview. The standardised differences (effect size) of perceived change using the SF-36 and WOMAC scores before and after surgery were calculated. The factors associated with HRQOL one year after surgery were analysed using adjusted general linear models. Results. Although there was an overall improvement in most HRQOL domains of patients (n=672), 9% saw little improvement after surgery, with their scores at baseline and follow-up being very similar (small size effect: 0.0-0.4). Women, patients with low social support, with lower scores (worse) in perceived mental health and baseline HRQOL, and who declared that their condition was more severe, perceived a poorer HRQOL one year after surgery (P<.05). Conclusions. Factors associated to a worse prognosis one year after an arthroplasty have been identified and are consistent with other published studies. The assessment of HRQOL can be a key instrument for identifying possible patients without improvement, in order to assess alternatives to an intervention, or apply other interventions in order to improve the efficiency of the healthcare process(AU)

[Quality of life-associated factors at one year after total hip and knee replacement: a multicentre study in Catalonia]. / Factores relacionados con la calidad de vida al año de la artroplastia total de cadera y rodilla: estudio multicéntrico en Cataluña.

AIMS: To assess the health related quality of life (HRQOL) and associated factors of patients before, and one year after, total knee (TKA) and hip (THA) arthroplasty. METHODS: A quasi-experimental prospective study conducted in hospitals with different levels of complexity and volume in Catalonia, and on patients with an indication of a TKA or THA. Demographic and psychosocial variables were recorded, and the SF-36 and WOMAC, and a question on perception of change after surgery were administered to patients by telephone interview. The standardised differences (effect size) of perceived change using the SF-36 and WOMAC scores before and after surgery were calculated. The factors associated with HRQOL one year after surgery were analysed using adjusted general linear models. RESULTS: Although there was an overall improvement in most HRQOL domains of patients (n=672), 9% saw little improvement after surgery, with their scores at baseline and follow-up being very similar (small size effect: 0.0-0.4). Women, patients with low social support, with lower scores (worse) in perceived mental health and baseline HRQOL, and who declared that their condition was more severe, perceived a poorer HRQOL one year after surgery (P<.05). CONCLUSIONS: Factors associated to a worse prognosis one year after an arthroplasty have been identified and are consistent with other published studies. The assessment of HRQOL can be a key instrument for identifying possible patients without improvement, in order to assess alternatives to an intervention, or apply other interventions in order to improve the efficiency of the healthcare process.

[Arthroplasty registers as post-marketing surveillance systems: the Catalan Arthroplasty Register]. / Los registros de artroplastias como sistemas de vigilancia poscomercialización: el Registro de Artroplastias de Cataluña.

OBJECTIVE: The aim is to present the functioning and results of the Catalan Arthroplasty Registry (RACat). MATERIAL AND METHOD: The RACat arose by the initiative of the Catalan Society of Orthopaedic Surgery and Traumatology, the Catalan Health Service (CHS) and the Catalan Agency for Health Information Assessment and Quality. Publicly funded hospitals sent information through the Internet (CHS Applications website) on knee and hip arthroplasties: patient identification, hospital, joint (hip/knee), type (primary/revision), side of operation, date of surgery and prosthesis (manufacturer's name and reference number). The quality of the data is analysed regularly. We estimate the risk of replacement by the Kaplan-Meier method. RESULTS: A total of 52 hospitals out of 62 send data to RACat, and information on 36,951 knee and 26,477 hip arthroplasties is available. Data quality improved between 2005 and 2010. In 2010 coverage exceeded 70%, with side of operation 97%, and prostheses identification of 80%. The risk of replacement at three years was 3.3% (95% CI:3.1-3.6) for knee, 2.9% (95% CI:2.5-3.3) for total hip, and 2.5% (95% CI:2.0-3.1) for partial hip. DISCUSSION: Risk of replacement is higher than that observed in other registers, although data quality and its improvement over time should be taken into account. CONCLUSIONS: The information available in the RACat will help to establish a standard that will enable hospitals to compare results.

Los registros de artroplastias como sistemas de vigilancia poscomercialización: el Registro de Artroplastias de Cataluña / Arthroplasty registers as post-marketing surveillance systems: the Catalan Arthroplasty Register

Objetivo. El objetivo de este trabajo es presentar el funcionamiento y los resultados del Registro de Artroplastias de Cataluña (RACat). Material y método. El RACat surgió por iniciativa de la Sociedad Catalana de Cirugía Ortopédica y Traumatología, el Servicio Catalán de la Salud (SCS) y la Agencia de Información, Evaluación y Calidad en Salud. Los hospitales financiados públicamente envían mediante Internet (portal de aplicaciones, SCS) información sobre las artroplastias de rodilla y cadera: identificación del paciente, hospital, articulación (cadera/rodilla), tipo (primaria/recambio), lateralidad, fecha de cirugía y prótesis (fabricante y número de referencia). La calidad de los datos se analiza periódicamente. El riesgo de recambio se estima mediante el método de Kaplan-Meier. Resultados. En total 52 hospitales de 62 envían datos al RACat que dispone de información sobre 36.951 artroplastias de rodilla y 26.477 de cadera. La calidad de los datos mejoró entre 2005 y 2010, superando la cobertura el 70%, la información sobre lateralidad el 97% y la identificación de prótesis el 80%. El riesgo de recambio a los 3 años fue del 3,3% (IC 95%:3,1-3,6) para rodilla, del 2,9% (IC 95%:2,5-3,3) para las totales de cadera, y del 2,5% (IC 95%:2,0-3,1) para las parciales. Discusión. El riesgo de recambio es superior al observado en otros registros, aunque es necesario tener en cuenta la calidad de la información disponible y su mejora en el tiempo. Conclusiones. La información disponible en el RACat permitirá establecer un estándar de referencia que permita a los hospitales evaluar sus resultados (AU)

Objective. The aim is to present the functioning and results of the Catalan Arthroplasty Registry (RACat). Material and method. The RACat arose by the initiative of the Catalan Society of Orthopaedic Surgery and Traumatology, the Catalan Health Service (CHS) and the Catalan Agency for Health Information Assessment and Quality. Publicly funded hospitals sent information through the Internet (CHS Applications website) on knee and hip arthroplasties: patient identification, hospital, joint (hip/knee), type (primary/revision), side of operation, date of surgery and prosthesis (manufacturer's name and reference number). The quality of the data is analysed regularly. We estimate the risk of replacement by the Kaplan-Meier method. Results. A total of 52 hospitals out of 62 send data to RACat, and information on 36,951 knee and 26,477 hip arthroplasties is available. Data quality improved between 2005 and 2010. In 2010 coverage exceeded 70%, with side of operation 97%, and prostheses identification of 80%. The risk of replacement at three years was 3.3% (95% CI:3.1-3.6) for knee, 2.9% (95% CI:2.5-3.3) for total hip, and 2.5% (95% CI:2.0-3.1) for partial hip. Discussion. Risk of replacement is higher than that observed in other registers, although data quality and its improvement over time should be taken into account. Conclusions. The information available in the RACat will help to establish a standard that will enable hospitals to compare results (AU)

Brief report: The KIDSCREEN follow-up study on Health-related Quality of Life (HRQoL) in Spanish children and adolescents. Pilot test and representativeness.

The Spanish KIDSCREEN follow-up study reassessed the Spanish baseline sample (n=840) of the European KIDSCREEN study 3 years later (2006). The aims of this paper were to describe the KIDSCREEN follow-up study and the pilot test, and to analyze participation rates and representativeness. Instruments included the KIDSCREEN-52 HRQoL measure and a set of scales including the possible explanatory variables. Focus groups and individual interviews were carried out in a pilot test. Participants were compared with non-participants at baseline, and also with Eurostat census data. Twenty-two out of 24 subjects were interviewed in the pilot test. Fifteen items needed to be modified after the pilot test. Participation rate reached 54% (n=454). Participants (mean age=12.71 years old) were on average 6 months younger than non-participants (p=0.03), and from more educated families. KIDSCREEN follow-up instrumentation seems adequate for collecting factors with potential influence on HRQoL. Follow-up respondents' representativeness seems to be acceptable.

Management and outcomes in digestive cancer surgery: design and initial results of a multicenter cohort study.

BACKGROUND: most studies that analyze the influence of structure factors on clinical outcomes are retrospective, based on clinical-administrative databases, and mainly focusing on surgical volume. OBJECTIVE: to study variations in the process and outcomes of oncologic surgery for esophagus, stomach, pancreas, liver metastases and rectum cancers in Catalonia, as well as the factors associated with these variations. PATIENTS AND METHOD: a retrospective (2002) and prospective (2003-05) multicenter cohort study. Data forms were designed to collect patient, process, and care outcome characteristics before surgery, at hospital discharge, and at 3 and 6 months after discharge. Main outcome measures were hospital and follow-up mortality, complications, re-interventions, and relapse rates. RESULTS: 49 hospitals (80%) participated in the retrospective phase, 44 of which (90%) also participated in the prospective phase: 3,038 patients (98%) were included. No differences were observed in the profile of operated patients according to hospital level of complexity, but clinical-pathological staging and other functional status variables could not be assessed because of over 20% of missing values. There was significant variability in the volume of interventions as well as in certain aspects of the healthcare process depending on type of cancer and center complexity. High rates of esophageal cancer mortality (18.2% at discharge, 27.3% at 6 months) and of complications and re-interventions for all cancers assessed, especially rectal cancer (18.4% re-interventions at 6 months), were identified. CONCLUSIONS: the study of the variability identified will require adequate risk-adjustment and should take into account different structure factors. It is necessary that information included in medical records be improved.

Artroplastias de cadera y rodilla en el Sistema Nacional de Salud martes / Hip and knee replacement in the Spanish National Health System

Objetivo: Analizar las artroplastias de cadera y de rodilla y sus características en el Sistema Nacional de Salud. Material y método: Estudio transversal llevado a cabo de forma global y por comunidades autónomas de las altas por artroplastia total primaria de cadera (ATC) y por artroplastias totales primarias de rodilla (ATR), así como las de revisión a partir de datos clínico-administrativos de 2005. Se calcularon las tasas estandarizadas de ATC y de ATR por edad y sexo por 10.000 habitantes analizando su variabilidad a partir del componente sistemático de variación (CSV). De cada alta se analizó: sexo, edad, motivo de intervención, índice de comorbilidad de Charlson, estancia, mortalidad intrahospitalaria y tromboembolismo pulmonar (TEP). Se analizó la carga de la cirugía de revisión a partir del porcentaje que representó sobre el total de artroplastias. Resultados: Las tasas fueron de 4,3 en ATC y de 7,3 en ATR variando de 2,3 a 10,0 en ATC (CSV del 24,4%) y de 4,0 a 12,8 en ATR (CSV del 20,6%). La mayoría de los pacientes fueron mayores de 65 años. La artrosis fue el principal motivo de intervención con escasa variabilidad. El ICC fue en general 0. La estancia mediana fue de 9 días en ATC y de 8 días en ATR. La mortalidad varió entre el 0 y el 0,9% y el TEP varió entre el 0 y el 0,6%. La carga de revisión en cadera fue del 9,2% y del 7% en rodilla. Conclusiones: La variabilidad de las tasas y las características de los pacientes puede estar indicando diferencias en los criterios de indicación. Será necesario establecer criterios de indicación homogéneos y desarrollar instrumentos para la evaluación de los resultados (AU)

Purpose:To analyze hip and knee arthroplasties and their characteristics in the Spanish National Health System.Materials and Methods: A cross-sectional at the global and Spanish autonomous comunity level of discharges of patients subjected to primary and revision total hip (THR) and knee (TKR) arthroplasties on the basis of clinical-administrative data gathered in 2005. Standardized THR and TKR rates were calculated by age and gender per 10,000 inhabitants analyzing their variability as compared with sistematic component of variation (SCV) values. Of each discharge we analyzed gender, age, reason for the procedure, the Charlson comorbidity index (CCI), length of stay, in-hospital mortality and pulmonary thromboembolism (PTE). We also analyzed the burden represented by revision surgery on the basis of the number of revision procedures as a percentage of the total number of arthroplasties. Results: The rates obtained were 4.3 for THR and 7.3 for TKR, ranging from 2.3 to 10.0 in THR (SCV: 24.4%) and from 4.0 to 12.8 (SCV: 20.6%) in TKR. The majority of patients were older than 65 years. Osteoarthritis was the main reason for surgery with little variability. Generally speaking, the CCI was 0. Median length of stay was 9 days in THR and 8 in TKR. Mortality varied between 0% and 0.9% and PTE between 0% and 0.6%. The percentage of hip revisions was 9.2% and that of knee revisions was 7%. Conclusions: Variability in terms of the different rates and patient characteristics could be pointing to differences in the indication criteria. Homogeneous indication criteria should be established and instruments should be developed for assessing the results (AU)

Criterios para priorizar a pacientes en lista de espera para procedimientos quirúrgicos en el Sistema Nacional de Salud / Criteria for prioritising patients on surgical waiting lists in the National Health System

Objetivo: Conocer la importancia de los criterios propuestos para la priorización de los pacientes en lista de espera quirúrgica en otros trabajos y analizar su utilización durante la práctica diaria. Material y métodos: Estudio transversal a partir de una encuesta postal autoadministrada a gerentes, directores médicos, responsables de admisiones y jefes de servicio de cirugía general, oftalmología, cirugía ortopédica y traumatología, y cirugía vascular de 139 centros. El cuestionario incluyó 3 secciones: a) se escogían los 3 a 5 criterios más importantes y se valoraba su utilización durante la práctica diaria; b) se proponían nuevos criterios, y c) datos sociodemográficos. Se calculó la media de la importancia de cada criterio y su desviación estándar. Los criterios propuestos se categorizaron y se calculó su frecuencia. Resultados: Respondió el 22% de los encuestados. La gravedad de la enfermedad, la rapidez de la progresión de la enfermedad, el tiempo de espera y el dolor fueron los criterios considerados más importantes y los más utilizados. La situación clínica actual y el entorno del profesional fueron las 2 categorías más frecuentes definidas a partir de los criterios propuestos por los encuestados. Conclusiones: El orden de intervención debería estar determinado por otros criterios relacionados con la necesidad de la cirugía, aparte del tiempo de espera. Establecer criterios de priorización permitiría hacer explícitos los criterios empleados ya de forma implícita (AU)

Objective: To survey the importance of previously proposed criteria for prioritising patients on surgical waiting lists and to analyse their use in daily practice. Material and methods: Cross-sectional study through a self-auto-administered postal questionnaire to hospital managers, medical directors, admissions managers, and department heads of general surgery, ophthalmology, orthopaedics and traumatology surgery and vascular surgery from 139 centres. The questionnaire comprised 3 sections: a) 3 to 5 of the most important criteria had to be selected and their use in daily practice had to be assessed; b) new criteria were proposed, c) socio-demographic data. The mean and its standard deviation of each criterion of importance were calculated. The proposed criteria were categorised and their frequency was calculated. Results: The questionnaire was answered by the 22% of those surveyed. Disease severity, speed of progression, waiting time and pain were the criteria considered as most important and were the most used. The current clinical situation and the professional environment were the two most common categories defined from the criteria proposed by those surveyed. Conclusions: The surgical priority should be determined by other criteria related to surgery necessity besides waiting time. Establishing prioritisation criteria could enable current implicit criteria to be used explicitly (AU)

Proceso asistencial y resultados en la cirugía de cáncer digestivo: diseño y resultados iniciales de un estudio de cohortes multicéntrico / Management and outcomes in digestive cancer surgery: design and initial results of a multicenter cohort study

Antecedentes: la mayoría de estudios que analizan la influenciade factores de estructura sobre los resultados son retrospectivos,realizados con bases de datos clínico-administrativas y basadosprincipalmente en el volumen de intervenciones.Objetivo: estudiar la variabilidad en el proceso y los resultadosde la cirugía oncológica de esófago, estómago, páncreas, metástasishepáticas y recto en Cataluña, así como los factores asociadosa esta.Pacientes y método: estudio de cohortes multicéntrico retrospectivo(2002) y prospectivo (2003-05). Se recogió informaciónsobre el paciente, el proceso y los resultados de la atenciónpreviamente a la cirugía, al alta, y a los 3 y 6 meses.Resultados: participaron 49 (80%) hospitales en la etapa retrospectiva,de los cuales 44 (90%) prosiguieron en la prospectiva.Se incluyeron 3.038 pacientes (98%). No se observaron diferenciasen el perfil de pacientes operados según el nivel de complejidaddel hospital pero no se pudo analizar el estadiaje clínico-patológicoy otras variables de estado funcional por presentar más del20% de valores ausentes. Existió una variabilidad importante en elvolumen de intervenciones por centro así como en algunos aspectosdel proceso asistencial según el tipo de cáncer y la complejidaddel centro. Se identificaron elevadas tasas de mortalidad en esófago(18,2% al alta, 27,3% a los 6 meses) y de complicaciones yreintervenciones en todos los cánceres evaluados, especialmenteen cáncer de recto (18,4% de reintervenciones a los 6 meses).Conclusiones: el estudio de la variabilidad identificada requeriráun adecuado ajuste del riesgo y debería tener en cuenta diferentesfactores de estructura. Es necesario mejorar la informaciónrecogida en la historia clínica(AU)

Background: most studies that analyze the influence of structurefactors on clinical outcomes are retrospective, based on clinical-administrative databases, and mainly focusing on surgical volume.Objective: to study variations in the process and outcomes ofoncologic surgery for esophagus, stomach, pancreas, liver metastasesand rectum cancers in Catalonia, as well as the factors associatedwith these variations.Patients and method: a retrospective (2002) and prospective(2003-05) multicenter cohort study. Data forms were designedto collect patient, process, and care outcome characteristicsbefore surgery, at hospital discharge, and at 3 and 6 monthsafter discharge. Main outcome measures were hospital and followupmortality, complications, re-interventions, and relapse rates.Results: 49 hospitals (80%) participated in the retrospectivephase, 44 of which (90%) also participated in the prospectivephase: 3,038 patients (98%) were included. No differences wereobserved in the profile of operated patients according to hospitallevel of complexity, but clinical-pathological staging and otherfunctional status variables could not be assessed because of over20% of missing values. There was significant variability in the volumeof interventions as well as in certain aspects of the healthcareprocess depending on type of cancer and center complexity. Highrates of esophageal cancer mortality (18.2% at discharge, 27.3%at 6 months) and of complications and re-interventions for all cancersassessed, especially rectal cancer (18.4% re-interventions at6 months), were identified.Conclusions: the study of the variability identified will requireadequate risk-adjustment and should take into account differentstructure factors. It is necessary that information included in medicalrecords be improved(AU)

[Criteria for prioritising patients on surgical waiting lists in the National Health System]. / Criterios para priorizar a pacientes en lista de espera para procedimientos quirúrgicos en el Sistema Nacional de Salud.

OBJECTIVE: To survey the importance of previously proposed criteria for prioritising patients on surgical waiting lists and to analyse their use in daily practice. MATERIAL AND METHODS: Cross-sectional study through a self-auto-administered postal questionnaire to hospital managers, medical directors, admissions managers, and department heads of general surgery, ophthalmology, orthopaedics and traumatology surgery and vascular surgery from 139 centres. The questionnaire comprised 3 sections: a) 3 to 5 of the most important criteria had to be selected and their use in daily practice had to be assessed; b) new criteria were proposed, c) socio-demographic data. The mean and its standard deviation of each criterion of importance were calculated. The proposed criteria were categorised and their frequency was calculated. RESULTS: The questionnaire was answered by the 22% of those surveyed. Disease severity, speed of progression, waiting time and pain were the criteria considered as most important and were the most used. The current clinical situation and the professional environment were the two most common categories defined from the criteria proposed by those surveyed. CONCLUSIONS: The surgical priority should be determined by other criteria related to surgery necessity besides waiting time. Establishing prioritisation criteria could enable current implicit criteria to be used explicitly.

Changes in health-related quality of life (HRQoL) in a population-based sample of children and adolescents after 3 years of follow-up.

OBJECTIVES: To assess changes in health-related quality of life (HRQoL) in children and adolescents over a 3-year period and to examine factors associated with change. METHODS: A representative sample of Spanish children and adolescents aged 8-18 years and their parents completed the KIDSCREEN-52 questionnaire at baseline and again after 3 years. Data were also collected on gender, pubertal development (PD), and family socio-economic status (SES). Change in HRQOL over time was evaluated using effect sizes (ES). Generalized estimating equations (GEE) were used to analyze associations among changes in KIDSCREEN scores, socio-demographic factors, and pubertal development. RESULTS: Response rate at follow-up was 54% (n = 454). Overall, HRQoL worsened in eight out of the ten KIDSCREEN dimensions, with ES ranging from -0.10 (Moods and Emotions) to -0.34 (Psychological Well-being). The decrease was most marked in the intermediate age group (13-17 years of age at follow-up) and in girls. In the GEE models, pubertal development more strongly impacted changes in girls than in boys. CONCLUSIONS: In this representative, population-based sample of children and adolescents, moderate decrements in HRQoL were observed after 3 years. Changes were particularly important among girls and in relation to pubertal development. These results could provide useful reference data for other longitudinal studies in population sub-groups.

Wide social participation in prioritizing patients on waiting lists for joint replacement: a conjoint analysis.

OBJECTIVE: The aim was to develop a priority scoring system for patients on waiting lists for joint replacement based on a wide social participation, and to analyze the differences among participants. METHODS: Conjoint analysis. Focus groups in combination with a nominal technique were employed to identify the priority criteria (N=36). A rank-ordered logit model was then applied for scoring estimations. Participants (N=860) represented: consultants, allied-health professionals, patients and their relatives, and the general population of Catalonia. RESULTS: Clinical and social criteria were selected, and their relative importance (over 100 points) was: pain (33), difficulty in doing activities of daily living (21), disease severity (18), limitations on ability to work (10), having someone to look after the patient (9), being a caregiver (6), and recovery probability (4). Estimated criteria coefficients had the expected positive sign and all were statistically significant (P < 0.001). There were differences between groups; pain was rated higher by patients/relatives, and difficulty in doing activities was rated lower by patients/relatives and the general public. Most interaction terms for these criteria and groups were significant (P < 0.001). Consultants and allied-health professionals had the most similar prioritization pattern (r=0.97). CONCLUSION: Both clinical and social criteria are considered for prioritization of joint replacement surgery from a wide social perspective. The preference among professional and social groups varies and this might impact the result of patient prioritization. A wide social participation for obtaining adequate prioritizing systems for patients on waiting lists is desirable.

Measuring case-mix and outcome for older people in acute hospital care across Europe: the development and potential of the ACMEplus instrument.

AIM: To identify case-mix variables measured shortly after admission to be included in a patient classification system (ACMEplus) that best explains hospital outcome for older people in different health care systems. DESIGN: Observational prospective cohort study collecting patient factors (sociodemographics, functional, mental, clinical, administrative and perceived health) at different time assessments. METHODS: Multicentre study involving eight hospitals in six European countries (United Kingdom, Spain, Italy, Finland, Greece and Poland). It included consecutive patients aged 65 years or older admitted to hospital for acute medical problems. MAIN OUTCOME MEASURES: discharge status, hospital readmission, mortality and length of stay. RESULTS: Of the 1667 included patients (mean age = 78.1 years; male gender = 43.5%) two-third had at least one 'Geriatric Giant' (immobility, confusion, incontinence or falls) on admission or shortly after. The most frequently affected system was cardiovascular (29.2%) and 31% of patients declared poor or very poor health. Mean length of stay was 17.9 days, 79% of patients were discharged to their usual residence; in-hospital and 1-month follow up mortality were 7.4% and 11.6%, respectively. Physical function explained the highest variation (between 8% and 21%), followed by cognitive status and number of Geriatric Giants, for almost all outcomes except readmission. CONCLUSION: Factors other than diagnosis (physical function, cognition and presenting problems) are important in predicting key outcomes of acute hospital care for older people and are consistent across countries. Their inclusion in a standardized system of measurement may be a way of improving quality and equity of medical care in older people.