Wessling M, Gravius S, Gebert C, Smektala R, Günster C, Hardes J, Rhomberg I, Koller D
Abteilung für Revisions- und Tumororthopädie, Orthopädische Klinik Volmarstein, Wetter.
Klinik für Orthopädie und Unfallchirurgie, Universitätsklinik Bonn.
Z Orthop Unfall. 2016 Feb;154(1):63-71. doi: 10.1055/s-0041-107670. Epub 2015 Nov 20.
External quality assurance for revisions of total knee arthroplasty (TKA) and total hip arthroplasty (THA) are carried out through the AQUA institute in Germany. Data are collected by the providers and are analyzed based on predefined quality indicators from the hospital stay in which the revision was performed. The present study explores the possibility to add routine data analysis to the existing external quality assurance (EQS). Differences between methods are displayed. The study aims to quantify the benefit of an additional analysis that allows patients to be followed up beyond the hospitalization itself.
All persons insured in an AOK sickness fund formed the population for analysis. Revisions were identified using the same algorithm as the existing external quality assurance. Adverse events were defined according to the AQUA indicators for the years 2008 to 2011.The hospital stay in which the revision took place and a follow-up of 30 days were included. For re-operation and dislocation we also defined a 365 days interval for additional follow-up. The results were compared to the external quality control reports.
Almost all indicators showed higher events in claims data analysis than in external quality control. Major differences are seen for dislocation (EQS SD: 1.87 vs. claims data [cd] SD: 2.06 %, cd+30 d: 2.91 %, cd+365 d: 7.27 %) and reoperation (hip revision: EQS SD: 5.88 % vs. claims data SD: 8.79 % cd+30 d: 9.82 %, cd+365 d: 15.0 %/knee revision: EQS SD: 3.21 % vs. claims data SD: 4.07 %, cd+30 d: 4.6 %, cd+365 d: 15.43 %). Claims data could show additional adverse events for all indicators after the initial hospital stay, rising to 77 % of all events.
The number of adverse events differs between the existing external quality control and our claims data analysis. Claims data give the opportunity to complement existing methods of quality control though a longer follow-up, when many complications become evident.
全膝关节置换术（TKA）和全髋关节置换术（THA）翻修手术的外部质量保证是通过德国的AQUA机构开展的。数据由提供者收集，并根据翻修手术所在住院期间的预定义质量指标进行分析。本研究探讨了在现有外部质量保证（EQS）中增加常规数据分析的可能性。展示了不同方法之间的差异。该研究旨在量化额外分析的益处，这种分析能让患者在住院期之后得到随访。
AOK疾病保险基金的所有参保人员构成分析人群。使用与现有外部质量保证相同的算法识别翻修手术。根据2008年至2011年的AQUA指标定义不良事件。纳入翻修手术所在的住院期以及30天的随访期。对于再次手术和脱位，我们还定义了365天的额外随访期。将结果与外部质量控制报告进行比较。
几乎所有指标在索赔数据分析中的事件发生率都高于外部质量控制。脱位方面存在显著差异（EQS标准差：1.87% 对比索赔数据[cd]标准差：2.06%，cd + 30天：2.91%，cd + 365天：7.27%）以及再次手术方面（髋关节翻修：EQS标准差：5.88% 对比索赔数据标准差：8.79%，cd + 30天：9.82%，cd + 365天：15.0%/膝关节翻修：EQS标准差：3.21% 对比索赔数据标准差：4.07%，cd + 30天：4.6%，cd + 365天：15.43%）。索赔数据能够显示初始住院期之后所有指标的额外不良事件，这些事件占所有事件的比例上升至77%。
现有外部质量控制与我们的索赔数据分析中不良事件的数量有所不同。索赔数据提供了通过更长随访期补充现有质量控制方法的机会，因为许多并发症在此时会变得明显。
