Evidence-based Processes and Outcomes of Care (EPOC): Improving services and outcomes for joint replacement patients

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open access
Copyright: Copyright 2021, Whitlam Orthopaedic Research Centre
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Abstract
The data includes 1013 variables: participant demographic information, comorbid health conditions, acute care and surgical data (total primary joint replacement), patient-reported outcomes measures (Oxford Hip or Knee Score and EQ-5D) at baseline, 35, 90 and 365 days post-surgery, patient-reported satisfaction and perception of success of surgery, details of VTE and antimicrobial prophylaxis, rehabilitation and health service utilisation and any money spent in recovery. ANy identifying information (names, dates and sites have been removed).
Persistent link to this record
http://hdl.handle.net/1959.4/resource/collection/resdatac_1261/1
DOI
https://doi.org/10.26190/c46r-ne05
Link to External Data Repository
Electronic Location
Contact Information
Research Data Creator(s)
Lead Chief Investigator
Other Contributor(s)
Corporate/Industry Contributor(s)
Publication Year
2021
Resource Type
Dataset
Keyword(s)
Total joint replacement
Arthroplasty
Prophylaxis
Surgical site infection
Venous thromboembolism
Clinical guidelines
Surgical complications
Patient reported outcomes
UNSW Faculty
Files
download epoc_with_fu_data_R_LATEST_deidentified for public repository.csv 4.85 MB Comma-Separated Values File
download EPOC, Badge Paper 1_ Main analysis code.Rmd 45.67 KB R Markdown File
download EPOC, Badge Paper 1_ Supplementary analysis code.Rmd 18.67 KB R Markdown File
download EPOC_Badge_REDCAP Data dictionary.csv 280.51 KB Comma-Separated Values File
download EPOC, Badge Paper 2_ Main analysis code.Rmd 97.42 KB R Markdown File
Related dataset(s)
Related publication(s)
Clinical practice guideline compliance in orthopaedic surgery
(2022) Badge, Helen
Thesis
Primary total hip arthroplasty (THA) & total knee arthroplasty (TKA) are common, cost-effective surgeries that reduce the pain and disability caused by osteoarthritis. THA/TKA are associated with a small risk of complications, such as venous thromboembolism (VTE) and surgical site infection (SSI), resulting in poorer outcomes. VTE & SSI prophylaxis clinical practice guidelines exist, but it is unclear whether service providers comply, or whether this affects outcomes. Methods A prospective multi-centre cohort study was undertaken in consenting adults with OA having primary TKA/THA at one of 19 high-volume Australian public/private hospitals. Data were collected before and for one-year post-surgery. Compliance was calculated with the National Health & Medical Research Council (NHMRC) & Australian Orthopaedic Association (AOA) VTE clinical guidelines & Therapeutic Guidelines (TG) Antibiotic. Logistic and linear regression were undertaken to explore associations between clinical guideline non-compliance and complications and patient-reported outcomes (Oxford Hip/Knee Scores [OH/KS], EQ-5D), and cephalosporin prophylaxis and SSI. Results Data were analysed for 1875 participants. Clinical guideline non-compliance rates averaged 87% for TG Antibiotic, 65% for NHMRC VTE clinical guideline & 20.1% for AOA VTE clinical guideline. NHMRC VTE clinical guideline noncompliance was associated with an increased VTE risk (adjusted odds ratio [AOR]=2.83, 95%CI=1.59-5.28, p< 0.001) and with lower (worse) 1-year EQ-5D Index scores (β=-0.03, SE=0.008,p=0.002) & an inconsequential reduction in OH/KS (β=-0.76,SE=0.30,p=0.01). AOA VTE clinical guideline non-compliance reduced the risk of symptomatic 90-day VTE (AOR=0.1, 95%CI=0.0-0.4,p=0.01). TG Antibiotic noncompliance was associated with higher SSI risk (AOR=1.98, 95%CI=1.17-3.62,p=0.02) but not with PROMs. Reduced SSI risk was associated with cephalosporin dose (any SSI; AOR=0.68, 95%CI=0.47–0.99, p=0.05) and commencing antibiotics before skin incision (0-60 mins: any SSI, AOR=0.56,95%CI=0.36–0.89,p=0.01; DSSI, AOR=0.56,95%CI=0.36–0.89,p=0.01; ≥60 minutes: AOR=0.35, 95%CI=0.17-0.70,p=0.004; DSSI, AOR=0.35,95%CI=0.17-0.70,p=0.004). Changing dose (AOR=1.76, 95%CI=1.22–2.57,p=0.02) & receiving preoperative non-cephalosporin (AOR=1.35, 95%CI=1.01–1.81,p=0.04) increased SSI risk. Antibiotic prophylaxis duration was not associated with SSI. Summary Non-compliance with NHMRC VTE clinical guidelines & TG Antibiotic increased the risk of VTE & SSI. The contrary NHMRC & AOA VTE clinical guideline findings may be explained by AOA recommending aspirin. Increased compliance with high-quality VTE & antibiotic clinical guidelines may improve THA/TKA outcomes.
doi.org/10.1177/2309499018802493
doi.org/10.1371/journal.pone.0180090
doi.org/10.1371/journal.pone.0159799
doi.org/10.1177/2309499021992605
Related grant(s)
Helen Badge - HCF Health and medical reseearch foundation - HCF Health and medical reseearch foundation
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