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Validation of adverse events after hip arthroplasty : A Swedish multi-centre cohort study

Magneli, Martin; Unbeck, Maria; Rogmark, Cecilia LU ; Rolfson, Ola; Hommel, Ami LU ; Samuelsson, Bodil; Schildmeijer, Kristina; Sjöstrand, Desirée LU ; Gordon, Max and Skoldenberg, Olof (2019) In BMJ Open 9(3).
Abstract

Objectives Preventing adverse events (AEs) after orthopaedic surgery is a field with great room for improvement. A Swedish instrument for measuring AEs after hip arthroplasty based on administrative data from the national patient register is used by both the Swedish Hip Arthroplasty Register and the Swedish Association of Local Authorities and Regions. It has never been validated and its accuracy is unknown. The aim of this study was to validate the instrument's ability to detect AEs, and to calculate the incidence of AEs following primary hip arthroplasties. Design Retrospective cohort study using retrospective record review with Global Trigger Tool methodology in combination with register data. Setting 24 different hospitals in four... (More)

Objectives Preventing adverse events (AEs) after orthopaedic surgery is a field with great room for improvement. A Swedish instrument for measuring AEs after hip arthroplasty based on administrative data from the national patient register is used by both the Swedish Hip Arthroplasty Register and the Swedish Association of Local Authorities and Regions. It has never been validated and its accuracy is unknown. The aim of this study was to validate the instrument's ability to detect AEs, and to calculate the incidence of AEs following primary hip arthroplasties. Design Retrospective cohort study using retrospective record review with Global Trigger Tool methodology in combination with register data. Setting 24 different hospitals in four major regions of Sweden. Participants 2000 patients with either total or hemi-hip arthroplasty were recruited from the SHAR. We included both acute and elective patients. Primary and secondary outcome measures The sensitivity and specificity of the instrument. Adjusted cumulative incidence and incidence rate. Results The sensitivity for all identified AEs was 5.7% (95% CI: 4.9% to 6.7%) for 30 days and 14.8% (95% CI: 8.2 to 24.3) for 90 days, and the specificity was 95.2% (95% CI: 93.5% to 96.6%) for 30 days and 92.1% (95% CI: 89.9% to 93.8%) for 90 days. The adjusted cumulative incidence for all AEs was 28.4% (95% CI: 25.0% to 32.3%) for 30 days and 29.5% (95% CI: 26.0% to 33.8%) for 90 days. The incidence rate was 0.43 AEs per person-month (95% CI: 0.39 to 0.47). Conclusions The AE incidence was high, and most AEs occurred within the first 30 days. The instrument sensitivity for AEs was very low for both 30 and 90 days, but the specificity was high for both 30 and 90 days. The studied instrument is insufficient for valid measurements of AEs after hip arthroplasty.

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author
publishing date
type
Contribution to journal
publication status
published
subject
keywords
adverse events, global trigger tool, hip arthroplasty, orthopaedics, validation
in
BMJ Open
volume
9
issue
3
publisher
British Medical Journal Publishing Group
external identifiers
  • scopus:85062639586
ISSN
2044-6055
DOI
10.1136/bmjopen-2018-023773
language
English
LU publication?
no
id
d04175a1-1232-468d-9d22-100fc4cc136e
date added to LUP
2019-03-20 09:11:19
date last changed
2019-06-20 03:00:27
@article{d04175a1-1232-468d-9d22-100fc4cc136e,
  abstract     = {<p>Objectives Preventing adverse events (AEs) after orthopaedic surgery is a field with great room for improvement. A Swedish instrument for measuring AEs after hip arthroplasty based on administrative data from the national patient register is used by both the Swedish Hip Arthroplasty Register and the Swedish Association of Local Authorities and Regions. It has never been validated and its accuracy is unknown. The aim of this study was to validate the instrument's ability to detect AEs, and to calculate the incidence of AEs following primary hip arthroplasties. Design Retrospective cohort study using retrospective record review with Global Trigger Tool methodology in combination with register data. Setting 24 different hospitals in four major regions of Sweden. Participants 2000 patients with either total or hemi-hip arthroplasty were recruited from the SHAR. We included both acute and elective patients. Primary and secondary outcome measures The sensitivity and specificity of the instrument. Adjusted cumulative incidence and incidence rate. Results The sensitivity for all identified AEs was 5.7% (95% CI: 4.9% to 6.7%) for 30 days and 14.8% (95% CI: 8.2 to 24.3) for 90 days, and the specificity was 95.2% (95% CI: 93.5% to 96.6%) for 30 days and 92.1% (95% CI: 89.9% to 93.8%) for 90 days. The adjusted cumulative incidence for all AEs was 28.4% (95% CI: 25.0% to 32.3%) for 30 days and 29.5% (95% CI: 26.0% to 33.8%) for 90 days. The incidence rate was 0.43 AEs per person-month (95% CI: 0.39 to 0.47). Conclusions The AE incidence was high, and most AEs occurred within the first 30 days. The instrument sensitivity for AEs was very low for both 30 and 90 days, but the specificity was high for both 30 and 90 days. The studied instrument is insufficient for valid measurements of AEs after hip arthroplasty.</p>},
  articleno    = {023773},
  author       = {Magneli, Martin and Unbeck, Maria and Rogmark, Cecilia and Rolfson, Ola and Hommel, Ami and Samuelsson, Bodil and Schildmeijer, Kristina and Sjöstrand, Desirée and Gordon, Max and Skoldenberg, Olof},
  issn         = {2044-6055},
  keyword      = {adverse events,global trigger tool,hip arthroplasty,orthopaedics,validation},
  language     = {eng},
  number       = {3},
  publisher    = {British Medical Journal Publishing Group},
  series       = {BMJ Open},
  title        = {Validation of adverse events after hip arthroplasty : A Swedish multi-centre cohort study},
  url          = {http://dx.doi.org/10.1136/bmjopen-2018-023773},
  volume       = {9},
  year         = {2019},
}