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- Bengtsson, Albin, 1985, et al.
(author)
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Consistency in patient-reported outcomes after total hip replacement: A 6-year registry follow-up of 15,755 patients
- 2017
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In: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 88:5, s. 484-489
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Journal article (peer-reviewed)abstract
- Purpose - The primary objective in this study was to describe the patient-reported outcome measures (PROMs) of total hip replacement (THR) patients 6 years after index surgery. Second, we sought to analyze how the preoperative, 1- and 6-year outcomes were associated. Patients and methods - By assessing the Swedish Hip Arthroplasty Register (SHAR), 15,755 patients with complete follow-up were included in the study group. 1-year and 6-year response rates were 93% and 87%. PROMs used by the SHAR include the EQ-5D instrument, and 2 modified visual analogue scales, 1 for pain and 1 for satisfaction. We used a multivariable linear regression model to examine the relationship between preoperative, 1-year, and 6-year outcome. Results - On average, patient-reported outcomes 6 years after THR were satisfactory. Though there was some deterioration in all mean 6-year PROMs, the patient-reported outcome after 6 years strongly resembled that of the 1-year results. The 1-year follow-up was the strongest factor associated with the 6-year results. Interpretation - There is little deterioration in patient-reported outcomes 6 years after THR compared with the 1-year results. Although the 1-year follow-up was the strongest predictor of the 6-year results it could not alone explain the results, thus supporting the utility of the 6-year follow-up in THR patients.
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| 2. |
- Fawsitt, C. G., et al.
(author)
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Choice of Prosthetic Implant Combinations in Total Hip Replacement: Cost-Effectiveness Analysis Using UK and Swedish Hip Joint Registries Data
- 2019
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In: Value in Health. - : Elsevier BV. - 1098-3015. ; 22:3, s. 303-312
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Journal article (peer-reviewed)abstract
- Background: Prosthetic implants used in total hip replacements (THR) have a range of bearing surface combinations (metal-onpolyethylene, ceramic-on-polyethylene, ceramic-on-ceramic, and metal-on-metal), head sizes (small [<36 mm in diameter] and large [>= 36 mm in diameter]), and fixation techniques (cemented, uncemented, hybrid, and reverse hybrid). These can influence prosthesis survival, patients' quality of life, and healthcare costs. Objectives: To compare the lifetime cost-effectiveness of implants for patients of different age and sex profiles. Methods: We developed a Markov model to compare the cost-effectiveness of various implants against small-head cemented metal-on-polyethylene implants. The probability that patients required 1 or more revision surgeries was estimated from analyses of more than 1 million patients in the UK and Swedish hip joint registries, for men and women younger than 55, 55 to 64, 65 to 74, 75 to 84, and 85 years and older. Implant and healthcare costs were estimated from local procurement prices, national tariffs, and the literature. Quality-adjusted life-years were calculated using published utility estimates for patients undergoing THR in the United Kingdom. Results: Small-head cemented metal-on-polyethylene implants were the most cost-effective for men and women older than 65 years. These findings were robust to sensitivity analyses. Small-head cemented ceramic-on-polyethylene implants were most cost-effective in men and women younger than 65 years, but these results were more uncertain. Conclusions: The older the patient group, the more likely that the cheapest implants, small-head cemented metal-on-polyethylene implants, were cost-effective. We found no evidence that uncemented, hybrid, or reverse hybrid implants were the most cost-effective option for any patient group. Our findings can influence clinical practice and procurement decisions for healthcare payers worldwide.
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| 4. |
- Gordon, Max, et al.
(author)
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The influence of comorbidity scores on re-operations following primary total hip replacement: Comparison and validation of three comorbidity measures.
- 2013
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In: The bone & joint journal. - 2049-4408. ; 95-B:9, s. 1184-1191
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Journal article (peer-reviewed)abstract
- While an increasing amount of arthroplasty articles report comorbidity measures, none have been validated for outcomes. In this study, we compared commonly used International Classification of Diseases-based comorbidity measures with re-operation rates after total hip replacement (THR). Scores used included the Charlson, the Royal College of Surgeons Charlson, and the Elixhauser comorbidity score. We identified a nationwide cohort of 134423 THRs from the Swedish Hip Arthroplasty Register. Re-operations were registered post-operatively for up to 12 years. The hazard ratio was estimated by Cox's proportional hazards regression, and we used C-statistics to assess each measure's ability to predict re-operation. Confounding variables were age, gender, type of implant fixation, hospital category, hospital implant volume and year of surgery. In the first two years only the Elixhauser score showed any significant relationship with increased risk of re-operation, with increased scores for both one to two and three or more comorbidities. However, the predictive C-statistic in this period for the Elixhauser score was poor (0.52). None of the measures proved to be of any value between two and 12 years. They might be of value in large cohort or registry studies, but not for the individual patient. Cite this article: Bone Joint J 2013;95-B:1184-91.
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| 5. |
- Goude, F, et al.
(author)
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Effects of competition and bundled payment on the performance of hip replacement surgery in Stockholm, Sweden: results from a quasi-experimental study
- 2022
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In: BMJ open. - : BMJ. - 2044-6055. ; 12:7, s. e061077-
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Journal article (peer-reviewed)abstract
- To evaluate the effects of competition and a bundled payment model on the performance of hip replacement surgery.DesignA quasi-experimental study where a difference-in-differences analytical framework is applied to analyse routinely collected patient-level data from multiple registers.SettingHospitals providing hip replacement surgery in Sweden.ParticipantsThe study included patients who underwent elective primary total hip replacement due to osteoarthritis from 2005 to 2012. The final study sample consisted of 85 275 hip replacement surgeries, where the exposure group consisted of 14 570 surgeries (n=6380 prereform and n=8190 postreform) and the control group consisted of 70 705 surgeries (n=32 799 prereform and n=37 906 postreform).InterventionA reform involving patient choice, free entry of new providers and a bundled payment model for hip replacement surgery, which came into force in 2009 in Region Stockholm, Sweden.Outcome measuresPerformance is measured as length of stay of the surgical admission, adverse event rate within 90 days following surgery and patient satisfaction 1 year postsurgery.ResultsThe reform successfully improved the adverse event rate (1.6 percentage reduction, p<0.05). Length of stay decreased less in the more competitive market than in the control group (0.7 days lower, p<0.01). These effects were mainly driven by university and central hospitals. No effects of the reform on patient satisfaction were found (no significance).ConclusionsThe study concludes that the incentives of the reform focusing on avoidance of adverse events have a predictable impact. Since the payment for providers is fixed per case, the impact on resource use is limited. Our findings contribute to the general knowledge about the effects of financial incentives and market-oriented reforms.
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| 6. |
- Goude, F., et al.
(author)
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The productivity development of total hip arthroplasty in Sweden: A multiple registry-based longitudinal study using the Malmquist Productivity Index
- 2019
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In: Bmj Open. - : BMJ. - 2044-6055. ; 9:9
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Journal article (peer-reviewed)abstract
- Objective The increasing demand for total hip arthroplasty (THA) combined with limited resources in healthcare puts pressure on decision-makers in orthopaedics to provide the procedure at minimum costs and with good outcomes while maintaining or increasing access. The objective of this study was to analyse the development in productivity between 2005 and 2012 in the provision of THA. Design The study was a multiple registry-based longitudinal study. Setting and participants The study was conducted among 65 orthopaedic departments providing THA in Sweden from 2005 to 2012. Outcome measures The development in productivity was measured by Malmquist Productivity Index by relating department level total costs of THA to the number of non-cemented, hybrid and cemented THAs. We also break down the productivity change into changes in efficiency and technology. Results Productivity increased significantly in three periods (between 1.6% and 27.0%) and declined significantly in four periods (between 0.8% and 12.1%). Technology improved significantly in three periods (between 3.2% and 16.9%) and deteriorated significantly in two periods (between 10.2% and 12.6%). Significant progress in efficiency was achieved in two periods (ranging from 2.6% to 8.7%), whereas a significant regress was attained in one period (3.9%). For the time span as a whole, an average increase in productivity of 1.4% per year was found, where changes in efficiency contributed more to the improvement (1.1%) than did technical change (0.2%). Conclusions We found a slight improvement of productivity over time in the provision of THA, which was mainly driven by changes in efficiency. Further research is, however, needed where differences in quality of care and patient case mix between departments are taken into account. © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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