Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
Upper Limb Unit, Wrightington Hospital, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK.
Bone Joint J. 2024 Nov 1;106-B(11):1312-1320. doi: 10.1302/0301-620X.106B11.BJJ-2024-0427.R1.
The aim of this study was to review the provision of total elbow arthroplasties (TEAs) in England, including the incidence, the characteristics of the patients and the service providers, the types of implant, and the outcomes.
We analyzed the primary TEAs recorded in the National Joint Registry (NJR) between April 2012 and December 2022, with mortality data from the Civil Registration of Deaths dataset. Linkage with Hospital Episode Statistics-Admitted Patient Care (HES-APC) data provided further information not collected by the NJR. The incidences were calculated using estimations of the populations from the Office for National Statistics. The annual number of TEAs performed by surgeons and hospitals was analyzed on a national and regional basis.
A total of 3,891 primary TEAs were included. The annual incidence of TEA was between 0.72 and 0.82 per 100,000 persons before 2020 and declined to 0.4 due to a decrease in elective TEAs during the COVID-19 pandemic, with a slight recovery in 2022. Older patients, those of white ethnicity and females, were more likely to undergo TEA. Those who underwent elective TEA had a median wait of between 89 (IQR 41 to 221) and 122 days (IQR 74 to 189) in the years before 2021, and this increased to 183 days (IQR 66 to 350) in 2021. The number of TEAs performed by surgeons per annum remained unchanged, with a median of two (IQR 1 to 3). The median annual number of TEAs per region was three to six times higher than the median annual case load of the highest volume hospital in a region. Patients in the lowest socioeconomic group had a higher rate of serious adverse events and mortality (11%) when undergoing TEA for acute trauma.
In England, TEA is more common in older age groups, those of white ethnicity, and females. The COVID-19 pandemic affected the incidence of elective TEA and waiting times, and the provision of TEA has not yet recovered. The Getting it Right First Time recommendation of centralizing services to one centre per region could result in up to a six-fold increase in the number of TEAs being performed in some centres.
本研究旨在回顾英格兰全肘关节置换术（TEA）的实施情况，包括发病率、患者和服务提供者的特征、植入物类型以及治疗结果。
我们分析了 2012 年 4 月至 2022 年 12 月期间全国关节登记处（NJR）记录的初次 TEA，以及民事登记死亡数据集的死亡率数据。与医院入院患者护理事件统计（HES-APC）数据的链接提供了 NJR 未收集的其他信息。使用来自国家统计局的人群估计数计算发病率。按国家和地区分析外科医生和医院每年实施的 TEA 数量。
共纳入 3891 例初次 TEA。在 2020 年之前，TEA 的年发病率为每 10 万人 0.72 至 0.82 例，由于 COVID-19 大流行期间择期 TEA 减少，发病率降至 0.4 例，但 2022 年略有回升。年龄较大、白种人以及女性更有可能接受 TEA。接受择期 TEA 的患者在 2021 年之前的中位等待时间为 89（IQR 41 至 221）至 122 天（IQR 74 至 189），而 2021 年增加至 183 天（IQR 66 至 350）。外科医生每年实施的 TEA 数量保持不变，中位数为 2 例（IQR 1 至 3）。每个地区每年 TEA 数量中位数是该地区最高容量医院每年病例数的 3 至 6 倍。在因急性创伤接受 TEA 的情况下，社会经济地位最低的患者发生严重不良事件和死亡的比率（11%）较高。
在英格兰，TEA 在年龄较大、白种人以及女性中更为常见。COVID-19 大流行影响了择期 TEA 的发病率和等待时间，而 TEA 的提供尚未恢复。“首次正确治疗”的建议将服务集中到每个地区的一个中心，这可能导致一些中心的 TEA 数量增加多达 6 倍。
