Hip and knee replacement in the Spanish National Health System

Allepuz, A.; Serra-Sutton, V.; Espallargues, M.; Sarria, A.

doi:10.1016/S1988-8856(09)70183-X

Información del artículo

Resumen

Bibliografía

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Estadísticas

Abstract

Purpose

To analyze hip and knee arthroplasties and their characteristics in the Spanish National Health System.

Materials and methods

Using clinical-administrative data gathered in 2005, a nationwide and regional cross-sectional study was performed of the number of discharges of patients subjected to primary and revision total hip (THR) and knee (TKR) arthroplasties. Standardized THR and TKR rates were calculated by age and gender per 10,000 inhabitants analyzing their variability as compared with systematic component of variance (SCV) values. Of each discharge we analyzed gender, age, reason for the procedure, the Charlson comorbidity index (CCI), length of stay, in-hospital mortality and pulmonary thromboembolism (PTE). We also analyzed the work-load entailed by revision surgery on the basis of the number of revision procedures as a percentage of the total number of arthroplasties.

Results

The rates obtained were 4.3 for THR and 7.3 for TKR, ranging from 2.3 to 10.0 in THR (SCV: 24.4%) and from 4.0 to 12.8 (SCV: 20.6%) in TKR. The majority of patients were older than 65 years. Osteoarthritis was the main reason for surgery with little variability. Generally speaking, the CCI was 0. Median length of stay was 9 days in THR and 8 in TKR. Mortality varied between 0% and 0.9% and PTE between 0% and 0.6%. The percentage of hip revisions was 9.2% and that of knee revisions was 7%.

Conclusions

Variability in terms of the different rates and patient characteristics could be pointing to differences in the indication criteria. Homogeneous indication criteria should be established and instruments should be developed for assessing the results.

Keywords:

Hip replacement

Knee replacement

Variability in medical practice

Clinico-administrative data bases

Resumen

Objetivo

Analizar las artroplastias de cadera y de rodilla y sus características en el Sistema Nacional de Salud.

Material y método

Estudio transversal llevado a cabo de forma global y por comunidades autónomas de las altas por artroplastia total primaria de cadera (ATC) y por artroplastias totales primarias de rodilla (ATR), así como las de revisión a partir de datos clínicoadministrativos de 2005. Se calcularon las tasas estandarizadas de ATC y de ATR por edad y sexo por 10.000 habitantes analizando su variabilidad a partir del componente sistemático de variación (CSV). De cada alta se analizó: sexo, edad, motivo de intervención, índice de comorbilidad de Charlson, estancia, mortalidad intrahospitalaria y tromboembolismo pulmonar (TEP). Se analizó la carga de la cirugía de revisión a partir del porcentaje que representó sobre el total de artroplastias.

Resultados

Las tasas fueron de 4,3 en ATC y de 7,3 en ATR variando de 2,3 a 10,0 en ATC (CSV del 24,4%) y de 4,0 a 12,8 en ATR (CSV del 20,6%). La mayoría de los pacientes fueron mayores de 65 años. La artrosis fue el principal motivo de intervención con escasa variabilidad. El ICC fue en general 0. La estancia mediana fue de 9 días en ATC y de 8 días en ATR. La mortalidad varió entre el 0 y el 0,9% y el TEP varió entre el 0 y el 0,6%. La carga de revisión en cadera fue del 9,2% y del 7% en rodilla.

Conclusiones

La variabilidad de las tasas y las características de los pacientes puede estar indicando diferencias en los criterios de indicación. Será necesario establecer criterios de indicación homogéneos y desarrollar instrumentos para la evaluación de los resultados.

Palabras clave:

Artroplastias de cadera

Artroplastias de rodilla

Variabilidad en la práctica médica

Bases de datos clínico-administrativos

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