Osmanski-Zenk Katrin, Klinder Annett, Haas Holger, Mittelmeier Wolfram
Orthopaedic Clinic and Outpatient Clinic, University Medical Centre Rostock.
Centre for Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Bonn Community Hospital.
Z Orthop Unfall. 2020 Oct;158(5):481-489. doi: 10.1055/a-0997-6922. Epub 2020 Feb 25.
The annual report of EndoCert publishes the results of the quality indicators (QI) and key figures of all certified centres for joint replacement (EndoProthetikZentren - EPZ). For some results it seems that centres with fewer revisions might have higher complication rates. However, to avoid misinterpretation the results have to be evaluated in more detail. The influence of the quantity of the revisions or the revision quotient on the quality of outcome was investigated.
This study included all certified EPZ and centres of excellence for joint replacement (EPXmax) (n = 492) and evaluated the data from 2016. Centres beyond the action limit were identified with the help of funnel plots and a confidence limit of 99.7% as action limit. Additionally data of the quality indicators were analysed with ANCOVA. The level of significance was p < 0.05.
The comparison by ANCOVA with number of revisions as co-variate showed no differences in the complication rates when related to the quantity of revisions. When considering a so called revision quotient (ratio of revision to all joint replacements) significant differences in the rate of fractures and fissures as well as in mortality for hip replacements and also in mortality for knee replacements were observed.
EPZ with fewer revisions do not have higher complication rates than centers with high numbers of revisions. Thus, the quantity of revisions has no influence on the quality of the outcome, considering that on the basis of the data of the EndoCert system no risk adjustment of patient-specific data was performed. Therefore the revisioin quotient of an EPZ shows that quantity is not equal with quality.
EndoCert年度报告公布了所有经认证的关节置换中心（EndoProthetikZentren - EPZ）的质量指标（QI）和关键数据。对于一些结果，似乎翻修手术较少的中心并发症发生率可能更高。然而，为避免误解，必须对结果进行更详细的评估。研究了翻修手术数量或翻修率对手术效果质量的影响。
本研究纳入了所有经认证的EPZ和卓越关节置换中心（EPXmax）（n = 492），并评估了2016年的数据。借助漏斗图和99.7%的置信限作为行动限来识别超出行动限的中心。此外，使用协方差分析（ANCOVA）分析质量指标数据。显著性水平为p < 0.05。
以翻修手术数量作为协变量进行的ANCOVA比较显示，与翻修手术数量相关的并发症发生率没有差异。当考虑所谓的翻修率（翻修手术与所有关节置换手术的比例）时，观察到髋部置换手术的骨折和骨裂发生率以及死亡率，以及膝部置换手术的死亡率存在显著差异。
翻修手术较少的EPZ与翻修手术较多的中心相比，并发症发生率并不更高。因此，考虑到基于EndoCert系统的数据未对患者特定数据进行风险调整，翻修手术数量对手术效果质量没有影响。所以，一个EPZ的翻修率表明数量并不等同于质量。
