Your browser doesn't support javascript.
loading
Evidence base and practice variation in acute care processes for knee and hip arthroplasty surgeries.
Mayer, Marcel; Naylor, Justine; Harris, Ian; Badge, Helen; Adie, Sam; Mills, Kathryn; Descallar, Joseph.
Affiliation
  • Mayer M; Whitlam Orthopaedic Research Centre, Liverpool Hospital, Sydney, New South Wales, Australia.
  • Naylor J; South Western Sydney Clinical School, UNSW, Randwick, Australia.
  • Harris I; Technical University Munich, Munich, Bavaria, Germany.
  • Badge H; Whitlam Orthopaedic Research Centre, Liverpool Hospital, Sydney, New South Wales, Australia.
  • Adie S; South Western Sydney Clinical School, UNSW, Randwick, Australia.
  • Mills K; Ingham Institute for Applied Medical Research, Liverpool, Australia.
  • Descallar J; Whitlam Orthopaedic Research Centre, Liverpool Hospital, Sydney, New South Wales, Australia.
PLoS One ; 12(7): e0180090, 2017.
Article de En | MEDLINE | ID: mdl-28723917
BACKGROUND: Lack of evidence contributes to unnecessary variation in treatment costs and outcomes. This study aimed to identify from interventions historically used for total knee or hip arthroplasty (TKA, THA): i) if routine use is supported by high-level evidence; ii) whether surgeon use aligns with the evidence. METHODS: Part 1: Systematic search of electronic library databases for systematic reviews and practice guidelines concerning seven acute-care interventions. Intervention-specific recommendations concerning routine use were extracted by assessors. Part 2: Prospective medical record audit of the acute-care received by 1900 patients involving 120 orthopaedic surgeons. Surgeon use per intervention was summarized using caterpillar plots. Surgeon-specific routine and non-routine use was defined as use in ≥ 90% and ≤ 10% of patients, respectively. Primary analysis included only surgeons contributing ≥ 10 patients. RESULTS: Continuous passive motion (TKA): Routine use not recommended; 85.7% of surgeons did not use it routinely. Tranexamic Acid: Routine use recommended; 26.9% of surgeons used it routinely. Cryotherapy: Routine use not recommended; 45.7% of surgeons used it routinely for TKA; 31.8% used it routinely for THA. Intra-articular drainage: Routine use not recommended for TKA, but possible benefits for THA; 5.7% of surgeons used it routinely for TKA, 0.0% used it routinely for THA. Antibiotic loaded bone cement: Routine use for TKA not supported, recommendations for use for THA are inconsistent; 90.0% of surgeons used it routinely for TKA, 100.0% used it routinely for THA. Patella resurfacing (TKA): No recommendation could be made; 57.1% of surgeons routinely resurfaced the patella. Indwelling urinary catheterisation: Routine use recommended; 59.6% of surgeons used it routinely. CONCLUSION: Recommendations for routine use or not exist for some of the acute-care interventions examined. Surgeon practices vary widely even in the presence of high-level recommendations. It is unclear whether further evidence alone would lessen unwarranted practice variation.
Sujet(s)

Texte intégral: 1 Collection: 01-internacional Base de données: MEDLINE Sujet principal: Types de pratiques des médecins / Médecine factuelle / Arthroplastie prothétique de hanche / Arthroplastie prothétique de genou Type d'étude: Guideline / Prognostic_studies Limites: Humans Langue: En Journal: PLoS One Sujet du journal: CIENCIA / MEDICINA Année: 2017 Type de document: Article Pays d'affiliation: Australie Pays de publication: États-Unis d'Amérique

Texte intégral: 1 Collection: 01-internacional Base de données: MEDLINE Sujet principal: Types de pratiques des médecins / Médecine factuelle / Arthroplastie prothétique de hanche / Arthroplastie prothétique de genou Type d'étude: Guideline / Prognostic_studies Limites: Humans Langue: En Journal: PLoS One Sujet du journal: CIENCIA / MEDICINA Année: 2017 Type de document: Article Pays d'affiliation: Australie Pays de publication: États-Unis d'Amérique