Quality Assurance in Primary Total Knee Arthroplasty

Christos Koutras; Isabel Becker; Stavros Antoniou; Hansjoerg Heep

doi:doi:10.11648/j.js.20221002.12

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Quality Assurance in Primary Total Knee Arthroplasty

Christos Koutras, Isabel Becker, Stavros Antoniou, Hansjoerg Heep

Published in Journal of Surgery (Volume 10, Issue 2)

Received: 14 February 2022 Accepted: 1 March 2022 Published: 11 March 2022

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Abstract

This study aims to compare internal and external documentation methods, to assess differences in complication rates through time and the potential association of patient parameters with morbidity. Data concerning primary knee arthroplasties performed between 2004 and 2014 were prospectively collected. The Pearson’s chi-squared test or the Fisher’s exact test was used to compare internal with external data and complications documented during 2005-2009 and 2010-2014. The Mann-Whitney U test was used to compare continuous outcomes in the two periods. Furthermore, binary logistic regression analyses were performed with occurrence of surgical complications as dependent variable. The total number of knee arthroplasties was 2100. Postoperative complications were experienced by 212 patients (median age: 72 years) and 30% were male. A significant difference between the internal and external datasets was detected in the “inability to walk at discharge” (p<0.0001) and the “total number of complications” (p=0.02). A significant reduction of the complication rate was observed in the second observation period (p<0.0001). The variables “length of hospital stay” and “duration of operation” independently predicted the occurrence of complications. The observed reduction of complications through time may be attributed to acquired surgical experience and the application of quality assurance measures.

Published in	Journal of Surgery (Volume 10, Issue 2)
DOI	10.11648/j.js.20221002.12
Page(s)	62-66
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Arthroplasty, Replacement, Knee, Quality Assurance, Health Care, Data Collection

References

[1]	Jakob J, Marenda D, Sold M, et al. Quality of documentation of intraoperative and postoperative complications: improvement of documentation for a nationwide quality assurance program and comparison with routine data. Chirurg. 2014 Aug; 85 (8): 705-10.
[2]	Sozialgesetzbuch (SGB) Fünftes Buch (V), availableat: https://www.gesetze-im-internet.de/sgb_5/index.html (accessed 15 May 2017).
[3]	BQS - Bundesgeschäftsstelle Qualitätssicherung, availableat: https://www.bqs.de/ (accessed 15 May 2017).
[4]	AQUA – Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen.Sektorenübergreifende Qualitätssicherung, available at: https://www.aqua-institut.de/de/projekte/137a-sgb-v/ (accessed 15 May 2017).
[5]	Datensatz Knie-Totalendoprothesen-Erstimplantation, 17/5 (Spezifikation 2014 V02), available at: https://sqg.de/downloads/2014/V02/DokuBoegen/17-5.pdf (accessed 22 April 2019).
[6]	Templeton GF. A two-step approach for transforming continuous variables to normal: implications and recommendations for IS research. Communications of the Association for Information Systems. 2011 Jan 1; 28 (4): 41-58.
[7]	Lüring C, Freund A, Kirschner S, et al. Re-evaluation of the AOK hospital navigator with a focus on total knee replacement. Z Orthop Unfall. 2013 Aug; 151 (4): 401-6.
[8]	Solomon DH, Chibnik LB, Losina E, et al. Development of a preliminary index that predicts adverse events after total knee replacement. Arthritis Rheum. 2006 May; 54 (5): 1536-42.
[9]	Peersman G, Laskin R, Davis J, et al. Prolonged operative time correlates with increased infection rate after total knee arthroplasty. HSS J. 2006 Feb; 2 (1): 70-2.
[10]	Prasad N, Padmanabhan V, Mullaji A. Blood loss in total knee arthroplasty: an analysis of risk factors. Int Orthop. 2007 Feb; 31 (1): 39-44.
[11]	Horlocker TT, Hebl JR, Gali B, et al. Anesthetic, patient, and surgical risk factors for neurologic complications after prolonged total tourniquet time during total knee arthroplasty. Anesth Analg. 2006 Mar; 102 (3): 950-5.
[12]	Santaguida PL, Hawker GA, Hudak PL, et al. Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. Can J Surg. 2008 Dec; 51 (6): 428-36.
[13]	England SP, Stern SH, Insall JN, et al. Total knee arthroplasty in diabetes mellitus. Clin Orthop Relat Res. 1990 Nov; (260): 130-4.
[14]	Robertson F, Geddes J, Ridley D, et al. Patients with Type 2 diabetes mellitus have a worse functional outcome post knee arthroplasty: a matched cohort study. Knee. 2012 Aug; 19 (4): 286-9.
[15]	Jämsen E, Nevalainen P, Eskelinen A, et al. Obesity, diabetes, and preoperative hyperglycemia as predictors of periprosthetic joint infection: a single-center analysis of 7181 primary hip and knee replacements for osteoarthritis. J Bone Joint Surg Am. 2012 Jul 18; 94 (14): e101.
[16]	Marchant MH Jr, Viens NA, Cook C, et al. The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty. J Bone Joint Surg Am. 2009 Jul; 91 (7): 1621-9.
[17]	Malinzak RA, Ritter MA, Berend ME, et al. Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates. J Arthroplasty. 2009 Sep; 24 (6 Suppl): 84-8.
[18]	Berend KR, Lombardi AV Jr, Adams JB. Total knee arthroplasty in patients with greater than 20 degrees flexion contracture. Clin Orthop Relat Res. 2006 Nov; 452: 83-7.
[19]	Kester BS, Merkow RP, Ju MH, et al. Effect of post-discharge venous thromboembolism on hospital quality comparisons following hip and knee arthroplasty. J Bone Joint Surg Am. 2014 Sep 3; 96 (17): 1476-84.
[20]	Jeschke E, Günster C, Klauber J. Quality assurance with administrative data (QSR): follow-up in quality measurement - an analysis of patient records. Z Evid Fortbild Qual Gesundhwes. 2015; 109 (9-10): 673-81.
[21]	AQUA, Qualitätsindikatoren 2014, 17/5 - Knie-Totalendoprothesen-Erstimplantation, available at: https://www.gqhnet.de/leistungsbereiche/diverses/indikatorenbeschreibungen-und-bundesauswertungen/indikatorenbeschreibungen/2014/AQUA_17n5_Indikatoren_2014.pdf (accessed 27 April 2019).
[22]	Osmanski-Zenk K, Steinig NS, Glass Ä, et al. Quality of Outcome after Primary Total Hip Replacement at a Maximum Care Hospital in Relation to Preoperative Influencing Factors. Z Orthop Unfall. 2015 Dec; 153 (6): 624-9.

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APA Style

Christos Koutras, Isabel Becker, Stavros Antoniou, Hansjoerg Heep. (2022). Quality Assurance in Primary Total Knee Arthroplasty. Journal of Surgery, 10(2), 62-66. https://doi.org/10.11648/j.js.20221002.12

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ACS Style

Christos Koutras; Isabel Becker; Stavros Antoniou; Hansjoerg Heep. Quality Assurance in Primary Total Knee Arthroplasty. J. Surg. 2022, 10(2), 62-66. doi: 10.11648/j.js.20221002.12

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AMA Style

Christos Koutras, Isabel Becker, Stavros Antoniou, Hansjoerg Heep. Quality Assurance in Primary Total Knee Arthroplasty. J Surg. 2022;10(2):62-66. doi: 10.11648/j.js.20221002.12

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@article{10.11648/j.js.20221002.12,
  author = {Christos Koutras and Isabel Becker and Stavros Antoniou and Hansjoerg Heep},
  title = {Quality Assurance in Primary Total Knee Arthroplasty},
  journal = {Journal of Surgery},
  volume = {10},
  number = {2},
  pages = {62-66},
  doi = {10.11648/j.js.20221002.12},
  url = {https://doi.org/10.11648/j.js.20221002.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20221002.12},
  abstract = {This study aims to compare internal and external documentation methods, to assess differences in complication rates through time and the potential association of patient parameters with morbidity. Data concerning primary knee arthroplasties performed between 2004 and 2014 were prospectively collected. The Pearson’s chi-squared test or the Fisher’s exact test was used to compare internal with external data and complications documented during 2005-2009 and 2010-2014. The Mann-Whitney U test was used to compare continuous outcomes in the two periods. Furthermore, binary logistic regression analyses were performed with occurrence of surgical complications as dependent variable. The total number of knee arthroplasties was 2100. Postoperative complications were experienced by 212 patients (median age: 72 years) and 30% were male. A significant difference between the internal and external datasets was detected in the “inability to walk at discharge” (p<0.0001) and the “total number of complications” (p=0.02). A significant reduction of the complication rate was observed in the second observation period (p<0.0001). The variables “length of hospital stay” and “duration of operation” independently predicted the occurrence of complications. The observed reduction of complications through time may be attributed to acquired surgical experience and the application of quality assurance measures.},
 year = {2022}
}

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TY - JOUR
T1 - Quality Assurance in Primary Total Knee Arthroplasty
AU - Christos Koutras
AU - Isabel Becker
AU - Stavros Antoniou
AU - Hansjoerg Heep
Y1 - 2022/03/11
PY - 2022
N1 - https://doi.org/10.11648/j.js.20221002.12
DO - 10.11648/j.js.20221002.12
T2 - Journal of Surgery
JF - Journal of Surgery
JO - Journal of Surgery
SP - 62
EP - 66
PB - Science Publishing Group
SN - 2330-0930
UR - https://doi.org/10.11648/j.js.20221002.12
AB - This study aims to compare internal and external documentation methods, to assess differences in complication rates through time and the potential association of patient parameters with morbidity. Data concerning primary knee arthroplasties performed between 2004 and 2014 were prospectively collected. The Pearson’s chi-squared test or the Fisher’s exact test was used to compare internal with external data and complications documented during 2005-2009 and 2010-2014. The Mann-Whitney U test was used to compare continuous outcomes in the two periods. Furthermore, binary logistic regression analyses were performed with occurrence of surgical complications as dependent variable. The total number of knee arthroplasties was 2100. Postoperative complications were experienced by 212 patients (median age: 72 years) and 30% were male. A significant difference between the internal and external datasets was detected in the “inability to walk at discharge” (p<0.0001) and the “total number of complications” (p=0.02). A significant reduction of the complication rate was observed in the second observation period (p<0.0001). The variables “length of hospital stay” and “duration of operation” independently predicted the occurrence of complications. The observed reduction of complications through time may be attributed to acquired surgical experience and the application of quality assurance measures.
VL - 10
IS - 2
ER -

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Author Information

Christos Koutras

Department of Orthopaedic Surgery, St. Josef Krankenhaus Essen-Werden, University Medicine Essen, Essen, Germany
Isabel Becker

Medical School, University Duisburg-Essen, Essen, Germany
Stavros Antoniou

Medical School, European University Cyprus, Nicosia, Cyprus
Hansjoerg Heep

Department of Orthopaedic Surgery, St. Josef Krankenhaus Essen-Werden, University Medicine Essen, Essen, Germany

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Plain Text BibTeX RIS

APA Style

Christos Koutras, Isabel Becker, Stavros Antoniou, Hansjoerg Heep. (2022). Quality Assurance in Primary Total Knee Arthroplasty. Journal of Surgery, 10(2), 62-66. https://doi.org/10.11648/j.js.20221002.12

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ACS Style

Christos Koutras; Isabel Becker; Stavros Antoniou; Hansjoerg Heep. Quality Assurance in Primary Total Knee Arthroplasty. J. Surg. 2022, 10(2), 62-66. doi: 10.11648/j.js.20221002.12

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AMA Style

Christos Koutras, Isabel Becker, Stavros Antoniou, Hansjoerg Heep. Quality Assurance in Primary Total Knee Arthroplasty. J Surg. 2022;10(2):62-66. doi: 10.11648/j.js.20221002.12

Copy | Download

@article{10.11648/j.js.20221002.12,
  author = {Christos Koutras and Isabel Becker and Stavros Antoniou and Hansjoerg Heep},
  title = {Quality Assurance in Primary Total Knee Arthroplasty},
  journal = {Journal of Surgery},
  volume = {10},
  number = {2},
  pages = {62-66},
  doi = {10.11648/j.js.20221002.12},
  url = {https://doi.org/10.11648/j.js.20221002.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20221002.12},
  abstract = {This study aims to compare internal and external documentation methods, to assess differences in complication rates through time and the potential association of patient parameters with morbidity. Data concerning primary knee arthroplasties performed between 2004 and 2014 were prospectively collected. The Pearson’s chi-squared test or the Fisher’s exact test was used to compare internal with external data and complications documented during 2005-2009 and 2010-2014. The Mann-Whitney U test was used to compare continuous outcomes in the two periods. Furthermore, binary logistic regression analyses were performed with occurrence of surgical complications as dependent variable. The total number of knee arthroplasties was 2100. Postoperative complications were experienced by 212 patients (median age: 72 years) and 30% were male. A significant difference between the internal and external datasets was detected in the “inability to walk at discharge” (p<0.0001) and the “total number of complications” (p=0.02). A significant reduction of the complication rate was observed in the second observation period (p<0.0001). The variables “length of hospital stay” and “duration of operation” independently predicted the occurrence of complications. The observed reduction of complications through time may be attributed to acquired surgical experience and the application of quality assurance measures.},
 year = {2022}
}

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