Assessment on patient outcomes of primary hip replacement: an interrupted time series analysis from ‘The National Joint Registry of England and Wales’
Objectives Effects of the UK Department of Health’s national Enhanced Recovery After Surgery (ERAS) Programme on outcomes after primary hip replacement.Design Natural experimental study using interrupted time series to assess the changes in trends before, during and after ERAS implementation (April...
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BMJ Publishing Group
2019-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/11/e031599.full |
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| author | George Peat Cyrus Cooper Daniel Prieto-Alhambra Andrew Judge Amar Rangan Andrew J Carr Karen L Barker Nigel K Arden José Leal Andrew James Price Ray Fitzpatrick Cesar Garriga |
| author_facet | George Peat Cyrus Cooper Daniel Prieto-Alhambra Andrew Judge Amar Rangan Andrew J Carr Karen L Barker Nigel K Arden José Leal Andrew James Price Ray Fitzpatrick Cesar Garriga |
| author_sort | George Peat |
| collection | DOAJ |
| description | Objectives Effects of the UK Department of Health’s national Enhanced Recovery After Surgery (ERAS) Programme on outcomes after primary hip replacement.Design Natural experimental study using interrupted time series to assess the changes in trends before, during and after ERAS implementation (April 2009 to March 2011).Setting Surgeries in the UK National Joint Registry were linked with Hospital Episode Statistics containing inpatient episodes from National Health Service trusts in England and patient reported outcome measures.Participants Patients aged ≥18 years from 2008 to 2016.Main outcome measures Regression coefficients of monthly means of length of hospital stay, bed day cost, change in Oxford Hip Scores (OHS) 6 months post-surgery, complications 6 months post-surgery and revision rates 5 years post-surgery.Results 438 921 primary hip replacements were identified. Hospital stays shortened from 5.6 days in April 2008 to 3.6 in December 2016. There were also improvements in bed day costs (£7573 in April 2008 to £5239 in December 2016), positive change in self-reported OHS from baseline to 6 months post-surgery (17.7 points in April 2008 to 22.9 points in December 2016), complication rates (4.1% in April 2008 to 1.7% March 2016) and 5 year revision rates (5.9 per 1000 implant-years (95% CI 4.8 to 7.2) in April 2008 to 2.9 (95% CI 2.2 to 3.9) in December 2011). The positive trends in all outcomes started before ERAS was implemented and continued during and after the programme.Conclusions Patient outcomes after hip replacement have improved over the last decade. A national ERAS programme maintained this improvement but did not alter the existing rate of change. |
| format | Article |
| id | doaj-art-e01d7ca237ae43a5b862b83484c4a53c |
| institution | DOAJ |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-e01d7ca237ae43a5b862b83484c4a53c2025-08-20T02:48:43ZengBMJ Publishing GroupBMJ Open2044-60552019-11-0191110.1136/bmjopen-2019-031599Assessment on patient outcomes of primary hip replacement: an interrupted time series analysis from ‘The National Joint Registry of England and Wales’George Peat0Cyrus Cooper1Daniel Prieto-Alhambra2Andrew Judge3Amar Rangan4Andrew J Carr5Karen L Barker6Nigel K Arden7José Leal8Andrew James Price9Ray Fitzpatrick10Cesar Garriga114Keele University, Research Institute for Primary Care and Health Sciences, Keele, United Kingdom12 MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UKDepartment of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands3 Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK4 Department of Health Sciences, University of York, York, Yorkshire, UKNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UKNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UKNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK2University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom4 University of Oxford, Oxford, UKprofessor of public health1University of Oxford, Arthritis Research UK Centre for Osteoarthritis Pathogenesis Kennedy Institute of Rheumatology Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, United KingdomObjectives Effects of the UK Department of Health’s national Enhanced Recovery After Surgery (ERAS) Programme on outcomes after primary hip replacement.Design Natural experimental study using interrupted time series to assess the changes in trends before, during and after ERAS implementation (April 2009 to March 2011).Setting Surgeries in the UK National Joint Registry were linked with Hospital Episode Statistics containing inpatient episodes from National Health Service trusts in England and patient reported outcome measures.Participants Patients aged ≥18 years from 2008 to 2016.Main outcome measures Regression coefficients of monthly means of length of hospital stay, bed day cost, change in Oxford Hip Scores (OHS) 6 months post-surgery, complications 6 months post-surgery and revision rates 5 years post-surgery.Results 438 921 primary hip replacements were identified. Hospital stays shortened from 5.6 days in April 2008 to 3.6 in December 2016. There were also improvements in bed day costs (£7573 in April 2008 to £5239 in December 2016), positive change in self-reported OHS from baseline to 6 months post-surgery (17.7 points in April 2008 to 22.9 points in December 2016), complication rates (4.1% in April 2008 to 1.7% March 2016) and 5 year revision rates (5.9 per 1000 implant-years (95% CI 4.8 to 7.2) in April 2008 to 2.9 (95% CI 2.2 to 3.9) in December 2011). The positive trends in all outcomes started before ERAS was implemented and continued during and after the programme.Conclusions Patient outcomes after hip replacement have improved over the last decade. A national ERAS programme maintained this improvement but did not alter the existing rate of change.https://bmjopen.bmj.com/content/9/11/e031599.full |
| spellingShingle | George Peat Cyrus Cooper Daniel Prieto-Alhambra Andrew Judge Amar Rangan Andrew J Carr Karen L Barker Nigel K Arden José Leal Andrew James Price Ray Fitzpatrick Cesar Garriga Assessment on patient outcomes of primary hip replacement: an interrupted time series analysis from ‘The National Joint Registry of England and Wales’ BMJ Open |
| title | Assessment on patient outcomes of primary hip replacement: an interrupted time series analysis from ‘The National Joint Registry of England and Wales’ |
| title_full | Assessment on patient outcomes of primary hip replacement: an interrupted time series analysis from ‘The National Joint Registry of England and Wales’ |
| title_fullStr | Assessment on patient outcomes of primary hip replacement: an interrupted time series analysis from ‘The National Joint Registry of England and Wales’ |
| title_full_unstemmed | Assessment on patient outcomes of primary hip replacement: an interrupted time series analysis from ‘The National Joint Registry of England and Wales’ |
| title_short | Assessment on patient outcomes of primary hip replacement: an interrupted time series analysis from ‘The National Joint Registry of England and Wales’ |
| title_sort | assessment on patient outcomes of primary hip replacement an interrupted time series analysis from the national joint registry of england and wales |
| url | https://bmjopen.bmj.com/content/9/11/e031599.full |
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