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- Title
Monitoring surgical performance: an application to total hip replacement.
- Authors
Biau, David J.; Milet, Alexandre; Thévenin, Fabrice; Anract, Philippe; Porcher, Raphaël
- Abstract
Rationale, aims and objectives Inadequate surgical implantation of a hip replacement may result in decreased patient satisfaction and reduced implant survival. The objective was to monitor surgical performance in hip replacement. Method The study took place at a teaching centre. All primary total hip replacements were prospectively included in the series. For each hip replacement, intraoperative technical errors, cup and stem fixation and position, and postoperative complications were recorded. If all items rated were correct, the procedure was considered as correct. The Cumulative Sums (CUSUM) test was used to monitor the performance of the centre. A 90% proportion of successful procedures was considered as adequate performance and a 75% proportion of successful procedures was deemed as inadequate performance. Meetings were conducted to discuss the results of monitoring. Results Eighty-three total hip replacements were monitored. Overall, 28 procedures (34%) were considered inadequate. The most potent reasons for inadequate performance were cup positioning and stem fixation. The CUSUM test signalled after the second procedure that performance was inadequate. After the first meeting, despite an improvement was seen, the CUSUM test raised an alarm indicating inadequate performance. The study was stopped after the second meeting because of funding reasons before it could be demonstrated that performance had reached the desired level. Conclusion This study has demonstrated that implementing a dedicated system to monitor surgical performance in a teaching hospital improves the quality of implantation of total hip replacements. Nonetheless, the target of ninety percent of adequate primary total hip replacement could not be reached and efforts should be continued.
- Subjects
TOTAL hip replacement; ARTHROPLASTY; HIP surgery; PLASTIC surgery; ARTIFICIAL implants
- Publication
Journal of Evaluation in Clinical Practice, 2009, Vol 15, Issue 3, p420
- ISSN
1356-1294
- Publication type
Article
- DOI
10.1111/j.1365-2753.2008.01029.x