From the Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam.
Netherlands Institute for Health Services Research (NIVEL), Utrecht.
J Patient Saf. 2024 Aug 1;20(5):e59-e72. doi: 10.1097/PTS.0000000000001226. Epub 2024 Mar 7.
Patient safety is a core component of quality of hospital care and measurable through adverse event (AE) rates. A high-risk group are femoral neck fracture patients. The Dutch clinical guideline states that the treatment of choice is cemented total hip arthroplasty (THA) or hemiarthroplasty (HA). We aimed to identify the prevalence of AEs related to THA/HA in a sample of patients who died in the hospital.
We used data of a nationwide retrospective record review study. Records were systematically reviewed for AEs, preventability and contribution to the patient's death. We drew a subsample of THA/HA AEs and analyzed these cases.
Of the 2998 reviewed records, 38 patients underwent THA/HA, of whom 24 patients suffered 25 AEs (prevalence = 68.1%; 95% confidence interval, 51.4-81.2), and 24 contributed to death. Patients with a THA/HA AE were of high age (median = 82.5 y) and had severe comorbidity (Charlson score ≥5). The majority of THA/HA AEs had a patient-related cause and was considered partly preventable. Examples of suggested actions that might have prevented the AEs: refraining from surgery, adhering to medication guidelines, uncemented procedures, comprehensive presurgical geriatric assessment, and better postsurgical monitoring.
Our study shows a high prevalence of (fatal) adverse events in patients undergoing THA/HA. This seems particularly valid for cemented implants in frail old patients, indicating room for improvement of patient safety in this group. Therefore, we recommend physicians to engage in comprehensive shared decision making with these patients and decide on a treatment fitting to a patient's preexisting health status, preferences, and values.
患者安全是医院护理质量的核心组成部分，可以通过不良事件（AE）发生率来衡量。股骨颈骨折患者是一个高危群体。荷兰临床指南指出，首选的治疗方法是骨水泥全髋关节置换术（THA）或半髋关节置换术（HA）。我们旨在确定在医院死亡的患者样本中与 THA/HA 相关的 AE 发生率。
我们使用了一项全国性回顾性记录审查研究的数据。对 AE、可预防程度和对患者死亡的影响进行了系统回顾。我们抽取了 THA/HA AE 的子样本，并对这些病例进行了分析。
在审查的 2998 份记录中，有 38 名患者接受了 THA/HA，其中 24 名患者发生了 25 起 AE（发生率=68.1%；95%置信区间，51.4-81.2%），24 起与死亡有关。发生 THA/HA AE 的患者年龄较大（中位数=82.5 岁），且合并严重疾病（Charlson 评分≥5）。大多数 THA/HA AE 是由患者自身原因引起的，且被认为部分可预防。可能预防 AE 的措施建议：避免手术、遵守用药指南、使用非骨水泥固定、全面的术前老年评估和更好的术后监测。
我们的研究表明，接受 THA/HA 的患者发生（致命）不良事件的发生率较高。对于脆弱的老年患者的骨水泥植入物尤其如此，这表明在该人群中提高患者安全性还有改进空间。因此，我们建议医生与这些患者进行全面的共同决策，并根据患者的现有健康状况、偏好和价值观选择合适的治疗方法。
