Quintana J M, Aróstegui I, Azkarate J, Goenaga J I, Guisasola I, Alfageme A, Diego A
Unidad de Investigación, Hospital de Galdakao, Galdakao, Vizcaya, Spain.
Rheumatology (Oxford). 2000 Nov;39(11):1234-41. doi: 10.1093/rheumatology/39.11.1234.
To evaluate the appropriateness of the use of total hip replacement (THR) using explicit criteria developed by an expert panel.
Patients with a diagnosis of osteoarthritis who were undergoing THR in five public hospitals in Spain were included consecutively in the study during a 1-yr period. The appropriateness of the indication was judged by explicit criteria developed using a mutidisciplinary approach. Complications were measured 3 months after surgery. One year after discharge, pain, functional limitation and general health were measured.
After evaluation of 583 patients, 82 (13.6%) were considered to have undergone inappropriate procedures, and for 279 (46.2%) patients indication for the procedure was considered uncertain. Differences were found in the rate of appropriateness among some centres. One year after discharge, the perception of general health was slightly better in those patients who had been judged to have undergone an appropriate procedure.
The study identified a moderate percentage of inappropriately performed THR. When considered together with those cases that were judged to have uncertain indications, the results indicate that further studies should be done to identify patients who may have an inadequate benefit:risk ratio from this procedure.
采用专家小组制定的明确标准评估全髋关节置换术（THR）使用的合理性。
在1年期间，连续纳入西班牙五家公立医院中诊断为骨关节炎且正在接受THR的患者进行研究。使用多学科方法制定的明确标准来判断手术指征的合理性。术后3个月测量并发症情况。出院1年后，测量疼痛、功能受限和总体健康状况。
在评估了583例患者后，82例（13.6%）被认为接受了不适当的手术，279例（46.2%）患者的手术指征被认为不确定。部分中心在合理性比率方面存在差异。出院1年后，被判定接受了适当手术的患者对总体健康的感知略好。
该研究发现有一定比例的THR手术实施不当。将这些情况与手术指征被判定不确定的病例一起考虑时，结果表明应进一步开展研究，以确定可能从该手术中获益风险比不足的患者。
