Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden.
Department of Orthopaedics, Danderyd University Hospital Corp., Stockholm, Sweden.
BMJ Open. 2019 Mar 7;9(3):e023773. doi: 10.1136/bmjopen-2018-023773.
Preventing adverse events (AEs) after orthopaedic surgery is a field with great room for improvement. A Swedish instrument for measuring AEs after hip arthroplasty based on administrative data from the national patient register is used by both the Swedish Hip Arthroplasty Register and the Swedish Association of Local Authorities and Regions. It has never been validated and its accuracy is unknown. The aim of this study was to validate the instrument's ability to detect AEs, and to calculate the incidence of AEs following primary hip arthroplasties.
Retrospective cohort study using retrospective record review with Global Trigger Tool methodology in combination with register data.
24 different hospitals in four major regions of Sweden.
2000 patients with either total or hemi-hip arthroplasty were recruited from the SHAR. We included both acute and elective patients.
The sensitivity and specificity of the instrument. Adjusted cumulative incidence and incidence rate.
The sensitivity for all identified AEs was 5.7% (95% CI: 4.9% to 6.7%) for 30 days and 14.8% (95% CI: 8.2 to 24.3) for 90 days, and the specificity was 95.2% (95% CI: 93.5% to 96.6%) for 30 days and 92.1% (95% CI: 89.9% to 93.8%) for 90 days. The adjusted cumulative incidence for all AEs was 28.4% (95% CI: 25.0% to 32.3%) for 30 days and 29.5% (95% CI: 26.0% to 33.8%) for 90 days. The incidence rate was 0.43 AEs per person-month (95% CI: 0.39 to 0.47).
The AE incidence was high, and most AEs occurred within the first 30 days. The instrument sensitivity for AEs was very low for both 30 and 90 days, but the specificity was high for both 30 and 90 days. The studied instrument is insufficient for valid measurements of AEs after hip arthroplasty.
预防骨科手术后的不良事件（AE）是一个有很大改进空间的领域。一种基于全国患者登记处行政数据的瑞典髋关节置换术后 AE 测量仪器，被瑞典髋关节置换登记处和瑞典地方当局和地区协会同时使用。它从未经过验证，其准确性也未知。本研究的目的是验证该仪器检测 AE 的能力，并计算初次髋关节置换术后 AE 的发生率。
使用回顾性记录回顾的回顾性队列研究，结合全球触发工具方法和登记数据。
瑞典四个主要地区的 24 家不同医院。
从 SHAR 招募了 2000 名接受全髋关节或半髋关节置换术的患者。我们纳入了急性和择期患者。
仪器的灵敏度和特异性。调整后的累积发生率和发生率。
所有确定的 AE 的灵敏度在 30 天时为 5.7%（95%CI：4.9%至 6.7%），在 90 天时为 14.8%（95%CI：8.2%至 24.3%），特异性在 30 天时为 95.2%（95%CI：93.5%至 96.6%），在 90 天时为 92.1%（95%CI：89.9%至 93.8%）。所有 AE 的调整后的累积发生率在 30 天时为 28.4%（95%CI：25.0%至 32.3%），在 90 天时为 29.5%（95%CI：26.0%至 33.8%）。发生率为 0.43 例/人月（95%CI：0.39 至 0.47）。
AE 的发生率很高，大多数 AE 发生在 30 天内。该仪器对 30 天和 90 天的 AE 敏感性都非常低，但特异性都很高。该研究仪器对于髋关节置换术后 AE 的有效测量是不足的。
