Department of Orthopaedics, Leiden University Medical Centre, Postbus, Leiden, 9600, 2300 RC, the Netherlands.
Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands.
BMC Musculoskelet Disord. 2023 Jun 3;24(1):456. doi: 10.1186/s12891-023-06577-6.
To evaluate the extent to which publication of high-quality randomised controlled trials(RCTs) in 2018 was associated with a change in volume or trend of subacromial decompression(SAD) surgery in patients with subacromial pain syndrome(SAPS) treated in hospitals across various countries.
Routinely collected administrative data of the Global Health Data@work collaborative were used to identify SAPS patients who underwent SAD surgery in six hospitals from five countries (Australia, Belgium, Netherlands, United Kingdom, United States) between 01/2016 and 02/2020. Following a controlled interrupted time series design, segmented Poisson regression was used to compare trends in monthly SAD surgeries before(01/2016-01/2018) and after(02/2018-02/2020) publication of the RCTs. The control group consisted of musculoskeletal patients undergoing other procedures.
A total of 3.046 SAD surgeries were performed among SAPS patients treated in five hospitals; one hospital did not perform any SAD surgeries. Overall, publication of trial results was associated with a significant reduction in the trend to use SAD surgery of 2% per month (Incidence rate ratio (IRR) 0.984[0.971-0.998]; P = 0.021), but with large variation between hospitals. No changes in the control group were observed. However, publication of trial results was also associated with a 2% monthly increased trend (IRR 1.019[1.004-1.034]; P = 0.014) towards other procedures performed in SAPS patients.
Publication of RCT results was associated with a significantly decreased trend in SAD surgery for SAPS patients, although large variation between participating hospitals existed and a possible shift in coding practices cannot be ruled out. This highlights the complexities of implementing recommendations to change routine clinical practice even if based on high-quality evidence.
评估 2018 年高质量随机对照试验（RCT）的发表程度与在各国医院治疗肩峰下疼痛综合征（SAPS）患者的肩峰下减压（SAD）手术量或趋势的变化之间的关系。
使用全球健康数据@工作协作的常规收集的管理数据，确定了 2016 年 1 月至 2020 年 2 月期间在五个国家（澳大利亚、比利时、荷兰、英国、美国）的六家医院接受 SAD 手术的 SAPS 患者。采用控制中断时间序列设计，分段泊松回归比较了 RCT 发表前后（2016 年 1 月至 2018 年 1 月）和之后（2018 年 2 月至 2020 年 2 月）每月 SAD 手术的趋势。对照组由接受其他手术的肌肉骨骼患者组成。
共对五家医院治疗的 SAPS 患者进行了 3046 例 SAD 手术；一家医院未进行任何 SAD 手术。总体而言，试验结果的发表与 SAD 手术趋势的每月显著降低 2%相关（发病率比（IRR）0.984[0.971-0.998]；P=0.021），但各医院之间存在较大差异。对照组未观察到变化。然而，试验结果的发表也与 SAPS 患者接受的其他手术的每月增加 2%趋势相关（IRR 1.019[1.004-1.034]；P=0.014）。
RCT 结果的发表与 SAPS 患者的 SAD 手术趋势显著降低相关，尽管参与医院之间存在较大差异，并且不能排除编码实践可能发生变化。这突显了即使基于高质量证据，实施改变常规临床实践的建议的复杂性。
