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Title: Variability of indication criteria in knee and hip replacement: an observational study
Authors: Cobos, Raquel
Latorre, Amaia
Aizpuru, Felipe
Guenaga, Jose I
Sarasqueta, Cristina
Escobar, Antonio
García, Lidia
Herrera-Espiñeira, Carmen
metadata.dc.contributor.authoraffiliation: [Cobos,R;Latorre,A;Aizpuru,F] Health Research Unit of Alava, Basque Health Service Vitoria-Gasteiz, Álava, Spain. [Guenaga,JI] Santiago Hospital, Vitoria-Gasteiz, Álava, Spain. [ Sarasqueta,C] Donostia Hospital,San Sebastian, Guipuzcoa, Spain.[Escobar,A] Basurto Hospital, Bilbao, Vizcaya, Spain.[García,L] Canary Islands Foundation for Health Research (FUNCIS), Santa Cruz de Tenerife, Canary Islands, Spain. [Herrera-Espiñeira,C] Virgen de las Nieves Hospital, Granada, Spain. [Aizpuru, F; Sarasqueta,C; Escobar,A; García,L] Network Center for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain.[Aizpuru,F] University of Basque Country (UPV/EHU), Spain.
Keywords: Anciano;Artroplastia de Reemplazo de Cadera;Artroplastia de Reemplazo de Rodilla;Femenino;Humanos;Masculino;Mediana Edad;Variaciones Dependientes del Observador;Pautas en la Práctica de los Médicos;Estudios Prospectivos
metadata.dc.subject.mesh: Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Prosthesis Implantation::Arthroplasty, Replacement::Arthroplasty, Replacement, Hip
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Prosthesis Implantation::Arthroplasty, Replacement::Arthroplasty, Replacement, Knee
Medical Subject Headings::Check Tags::Female
Medical Subject Headings::Disciplines and Occupations::Social Sciences::Demography::Health Status
Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans
Medical Subject Headings::Check Tags::Male
Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Middle Aged
Medical Subject Headings::Health Care::Environment and Public Health::Public Health::Epidemiologic Factors::Observer Variation
Medical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Delivery of Health Care::Physician's Practice Patterns
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Prospective Studies
Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Aged
Issue Date: 26-Oct-2010
Publisher: BioMed Central
Citation: Cobos R ,Latorre A, Aizpuru F, Guenaga JI, Sarasqueta C, Escobar A, et al. Variability of indication criteria in knee and hip replacement: an observational study. BMC Musculoskelet Disord. 2010 Oct 26;11:249
Abstract: BACKGROUND. Total knee (TKR) and hip (THR) replacement (arthroplasty) are effective surgical procedures that relieve pain, improve patients' quality of life and increase functional capacity. Studies on variations in medical practice usually place the indications for performing these procedures to be highly variable, because surgeons appear to follow different criteria when recommending surgery in patients with different severity levels. We therefore proposed a study to evaluate inter-hospital variability in arthroplasty indication. METHODS. The pre-surgical condition of 1603 patients included was compared by their personal characteristics, clinical situation and self-perceived health status. Patients were asked to complete two health-related quality of life questionnaires: the generic SF-12 (Short Form) and the specific WOMAC (Western Ontario and Mcmaster Universities) scale. The type of patient undergoing primary arthroplasty was similar in the 15 different hospitals evaluated.The variability in baseline WOMAC score between hospitals in THR and TKR indication was described by range, mean and standard deviation (SD), mean and standard deviation weighted by the number of procedures at each hospital, high/low ratio or extremal quotient (EQ5-95), variation coefficient (CV5-95) and weighted variation coefficient (WCV5-95) for 5-95 percentile range. The variability in subjective and objective signs was evaluated using median, range and WCV5-95. The appropriateness of the procedures performed was calculated using a specific threshold proposed by Quintana et al for assessing pain and functional capacity. RESULTS. The variability expressed as WCV5-95 was very low, between 0.05 and 0.11 for all three dimensions on WOMAC scale for both types of procedure in all participating hospitals. The variability in the physical and mental SF-12 components was very low for both types of procedure (0.08 and 0.07 for hip and 0.03 and 0.07 for knee surgery patients). However, a moderate-high variability was detected in subjective-objective signs. Among all the surgeries performed, approximately a quarter of them could be considered to be inappropriate. CONCLUSIONS. A greater inter-hospital variability was observed for objective than for subjective signs for both procedures, suggesting that the differences in clinical criteria followed by surgeons when indicating arthroplasty are the main responsible factors for the variation in surgery rates.
Description: Comparative Study; Evaluation Studies; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't;
metadata.dc.identifier.doi: 10.1186/1471-2474-11-249
ISSN: 1471-2474
Appears in Collections:01- Artículos - Hospital Virgen de las Nieves

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