Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, UK.
Upper Limb Unit, Wrightington Hospital, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK.
J Orthop Surg Res. 2024 Aug 30;19(1):526. doi: 10.1186/s13018-024-04903-9.
Primary total elbow replacement (TER) services in England are being restructured with the goal of centralising care to specialised centres. It is important to monitor the impact of this service redesign. This protocol outlines an intended analysis to provide detailed descriptions of the patients who are receiving primary TER, where and by whom TER is being performed, and what the current surgical practices for TER are in England before the reconfiguration.
This analysis will use the National Joint Registry (NJR) elbow dataset and link it with NHS England Hospital Episode Statistics-Admitted Patient Care (HES-APC). It will include eligible patients from the start of the NJR elbow dataset in April 2012 to December 2022. The main objective is to determine the incidence of TER in England. Age-sex standardised rates will be calculated for groups including different ethnicities, and socioeconomic backgrounds, using the mid-year population data provided by the Office for National Statistics. This planned analysis will summarise patient characteristics such as age, sex, body mass index (BMI), hand dominance, American Society of Anaesthesiologists (ASA) grade, indication for TER, socioeconomic status, and patient co-morbidities. It will also examine implant fixation type, classification, brand/type, and changes over time in implant types used in England. Additionally, it will explore the characteristics and volume of the surgeons and hospitals providing primary TER services, including the grade of the primary surgeons, funding source for surgery, and admission type. The analysis will cover the number of procedures performed by surgeons and hospitals annually in England and in each region of England. Finally, the planned analysis will summarise the elective wait time, postoperative length of stay, and any serious adverse events or re-admissions within 30 and 90 days after the TER.
This protocol describes the first deep dive analysis into the NJR elbow dataset to describe the incidence of TER surgery in England and the characteristics of patients who are receiving it. This analysis will summarise current primary TER practices in England before service reconfigurations. The impact of reconfiguration can be monitored by comparing future practice to the outcomes from this study. Trial registration ClinicalTrials.gov, NCT06355011. Registered 02 April 2024, https://clinicaltrials.gov/ct2/show/NCT06355011 .
英国正在对原发性全肘置换术（TER）服务进行重组，目标是将护理集中到专门的中心。监测这种服务设计的影响非常重要。本方案概述了一项预期分析，旨在详细描述接受原发性 TER 的患者，TER 手术的地点和执行者，以及在重组之前英格兰目前的 TER 手术实践。
该分析将使用国家关节登记处（NJR）肘部数据集，并将其与英格兰国民保健署医院发病统计数据-住院患者护理（HES-APC）相关联。它将包括自 2012 年 4 月 NJR 肘部数据集开始至 2022 年 12 月期间符合条件的患者。主要目标是确定英国 TER 的发病率。将使用国家统计局提供的年中人口数据，为包括不同种族和社会经济背景的人群计算 TER 的年龄-性别标准化率。本计划分析将总结患者特征，如年龄、性别、体重指数（BMI）、手优势、美国麻醉医师协会（ASA）分级、TER 的适应证、社会经济状况和患者合并症。它还将研究植入物固定类型、分类、品牌/类型以及英格兰使用的植入物类型随时间的变化。此外，它将探讨提供原发性 TER 服务的外科医生和医院的特征和数量，包括初级外科医生的级别、手术资金来源和入院类型。该分析将涵盖英格兰每年和英格兰每个地区的外科医生和医院进行的手术数量。最后，计划分析将总结 TER 后 30 天和 90 天内的择期等待时间、术后住院时间以及任何 30 天和 90 天内的严重不良事件或再入院情况。
本方案描述了对 NJR 肘部数据集的首次深入分析，以描述英国 TER 手术的发病率以及接受该手术的患者特征。该分析将总结英格兰在服务重组前的当前原发性 TER 实践。可以通过将未来的实践与本研究的结果进行比较来监测重组的影响。
ClinicalTrials.gov，NCT06355011。注册于 2024 年 4 月 2 日，https://clinicaltrials.gov/ct2/show/NCT06355011。
