Ekhtiari Seper, Pincus Daniel, Ruangsomboon Pakpoom, Paterson J Michael, Ravi Bheeshma
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada.
Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
Int Orthop. 2025 Mar;49(3):589-594. doi: 10.1007/s00264-025-06423-5. Epub 2025 Feb 7.
Early major complications following total hip replacement (THR) occur rarely, but given the high volumes of THR, represent a major burden to patients and the system. The purpose of this study was to determine the influence of hospital-level surgical practices on early major complications across Ontario.
We conducted a population-based retrospective cohort study of all adults in Ontario, Canada who underwent primary THR for osteoarthritis between January 1, 2009 and December 31, 2019. The primary outcome was early major surgical complications (composite of deep infection, periprosthetic fracture, dislocation, or revision surgery occurring within 1 year of surgery). Medical complications (thromboembolism, myocardial infarction, pneumonia) occurring within 30 days of surgery also were assessed. THR performed at centres with very low volumes were excluded a priori. Two-level hierarchical logistic regression models adjusted for age, sex and Charlson co-morbidity score were used to calculate each hospital's unique adjusted complication rate and 95% confidence interval.
During the study period, 95,912 patients (mean [SD] age 67 [11.0] years; 51,216 (53.4%) women) underwent THA at 56 hospitals across Ontario. Overall, 1,656 (1.7%) patients had a major surgical complication within 1 year. Major surgical complication rates varied seven fold between hospitals from 0.6 to 4.1%. After adjustment, 4 of 56 hospitals were low outliers (adjusted complication rate significantly below average) and 5 of 56 were high outliers (adjusted complication rate significantly above average). There were no hospital outliers for medical complications.
There was significant variation in early major surgical complication rates between Ontario hospitals that persisted after adjustment for patient age, sex and medical comorbidity. Feeding back adjusted outcomes in benchmarking reports may enable individual hospitals and surgeons better consider their own performance and scale up best practices from low outlier hospitals, which can play a role in educating other centres in their region.
全髋关节置换术（THR）后的早期严重并发症很少发生，但鉴于THR手术量很大，这对患者和医疗系统来说是一个重大负担。本研究的目的是确定安大略省医院层面的手术操作对早期严重并发症的影响。
我们对2009年1月1日至2019年12月31日期间在加拿大安大略省因骨关节炎接受初次THR的所有成年人进行了一项基于人群的回顾性队列研究。主要结局是早期严重手术并发症（深部感染、假体周围骨折、脱位或术后1年内进行翻修手术的综合情况）。还评估了术后30天内发生的医疗并发症（血栓栓塞、心肌梗死、肺炎）。事先排除在手术量极低的中心进行的THR。使用针对年龄、性别和查尔森合并症评分进行调整的两级分层逻辑回归模型来计算每家医院独特的调整后并发症发生率和95%置信区间。
在研究期间，安大略省56家医院的95912例患者（平均[标准差]年龄67[11.0]岁；51216例（53.4%）为女性）接受了全髋关节置换术（THA）。总体而言，1656例（1.7%）患者在1年内出现了严重手术并发症。各医院之间的严重手术并发症发生率相差7倍，从0.6%到4.1%不等。调整后，56家医院中有4家是低异常值（调整后并发症发生率显著低于平均水平），56家中有5家是高异常值（调整后并发症发生率显著高于平均水平）。在医疗并发症方面没有医院异常值。
安大略省各医院之间早期严重手术并发症发生率存在显著差异，在对患者年龄、性别和医疗合并症进行调整后这种差异仍然存在。在基准报告中反馈调整后的结果可能会使各医院和外科医生更好地考虑自身表现，并推广低异常值医院的最佳做法，这有助于对该地区的其他中心进行培训。
