Abstract：
BACKGROUND: To assess the extent of between-hospital variation in revision following primary shoulder arthroplasty (SA), both overall and for specific revision indications to guide quality improvement initiatives, and to assess whether revision rates are suitable as quality indicators to reliably rank hospital performance.
METHODS: All primary SAs performed between 2014 and 2018 were included from the Dutch Arthroplasty Register to examine 1-year revision and all primary SAs performed between 2014 and 2016 for 1- and 3-year revisions. For each hospital, the observed number (O) of revisions was compared with that expected (E) based on case-mix and depicted in funnel plots with 95% control limits to identify outlier hospitals. The rankability (ie, the reliability of ranking hospitals) was calculated as the percentage of total hospital variation due to true between-hospital differences rather than chance and categorized as low (<50%), moderate (50%-75%), and high (>75%).
RESULTS: A total of 13,104 primary SAs (87 hospitals) in 2014-2018 were included, of which 7213 were performed between 2014 and 2016. Considerable between-hospital variation was found in 1-year revision in 2014-2016 (median 1.6%, interquartile range 0.0%-3.1%), identifying 3 outlier hospitals having overall significantly more revisions than expected (O/E range 1.9-2.3) and for specific indications (cuff pathology and infection). Results for 2014-2018 were similar. For 3-year revision, 3 outlier hospitals were identified (O/E range 1.7-3.3). Rankabilities for all outcomes were low.
CONCLUSIONS: Considerable between-hospital variation was observed for 1- and 3-year revision rates following primary SA, where outlier hospitals could be identified based on large differences in revision for specific indications to direct quality improvement initiatives. However, rankabilities were low, meaning that much of the other (smaller) variation in performance could not be detected, rendering revisions unsuitable to rank hospital performances following primary SA.
METHODS: All primary SAs performed between 2014 and 2018 were included from the Dutch Arthroplasty Register to examine 1-year revision and all primary SAs performed between 2014 and 2016 for 1- and 3-year revisions. For each hospital, the observed number (O) of revisions was compared with that expected (E) based on case-mix and depicted in funnel plots with 95% control limits to identify outlier hospitals. The rankability (ie, the reliability of ranking hospitals) was calculated as the percentage of total hospital variation due to true between-hospital differences rather than chance and categorized as low (<50%), moderate (50%-75%), and high (>75%).
RESULTS: A total of 13,104 primary SAs (87 hospitals) in 2014-2018 were included, of which 7213 were performed between 2014 and 2016. Considerable between-hospital variation was found in 1-year revision in 2014-2016 (median 1.6%, interquartile range 0.0%-3.1%), identifying 3 outlier hospitals having overall significantly more revisions than expected (O/E range 1.9-2.3) and for specific indications (cuff pathology and infection). Results for 2014-2018 were similar. For 3-year revision, 3 outlier hospitals were identified (O/E range 1.7-3.3). Rankabilities for all outcomes were low.
CONCLUSIONS: Considerable between-hospital variation was observed for 1- and 3-year revision rates following primary SA, where outlier hospitals could be identified based on large differences in revision for specific indications to direct quality improvement initiatives. However, rankabilities were low, meaning that much of the other (smaller) variation in performance could not be detected, rendering revisions unsuitable to rank hospital performances following primary SA.
摘要：
背景：为了评估初次肩关节置换术（SA）后翻修的医院间差异程度，总体和具体的修订指示，以指导质量改进举措，并评估修订率是否适合作为质量指标，以可靠地对医院绩效进行排名。
方法：2014年至2018年期间进行的所有主要SAs均纳入荷兰关节成形术注册，以检查1年的修订，以及2014年至2016年期间进行的1年和3年修订的所有主要SAs。每个医院,将观察到的修订数量(O)与基于病例组合的预期数量(E)进行比较,并在控制限度为95%的漏斗图中描绘,以识别异常医院.排名性(即，Thereliabilityofrankinghospitals)wascalculatedasthepercentageoftotalhospitalvariationduetotruebetween-hospitaldifferencesratherthanchanceandclassifiedaslow(<50%),中等（50%-75%），高（>75%）。
结果：包括2014-2018年的13,104所主要医院（87所医院），其中7213人在2014年至2016年期间进行。在2014-2016年的1年修订中发现了相当大的医院间差异(中位数为1.6%，四分位数区间0.0%-3.1%），确定3个异常医院，其总体修订量明显高于预期（O/E范围1.9-2.3）和特定适应症（袖带病理和感染）。2014-2018年的结果相似。对于3年的修订，确定了3家离群医院(O/E范围1.7-3.3)。所有结果的排名都很低。
结论：主要SA后1年和3年的翻修率在医院之间观察到相当大的差异，在那里，可以根据修订的具体适应症的巨大差异来确定离群医院，以指导质量改进举措。然而,排名很低，这意味着许多其他(较小的)性能变化无法检测到，使修订不适合对主要SA后的医院表现进行排名。
方法：2014年至2018年期间进行的所有主要SAs均纳入荷兰关节成形术注册，以检查1年的修订，以及2014年至2016年期间进行的1年和3年修订的所有主要SAs。每个医院,将观察到的修订数量(O)与基于病例组合的预期数量(E)进行比较,并在控制限度为95%的漏斗图中描绘,以识别异常医院.排名性(即，Thereliabilityofrankinghospitals)wascalculatedasthepercentageoftotalhospitalvariationduetotruebetween-hospitaldifferencesratherthanchanceandclassifiedaslow(<50%),中等（50%-75%），高（>75%）。
结果：包括2014-2018年的13,104所主要医院（87所医院），其中7213人在2014年至2016年期间进行。在2014-2016年的1年修订中发现了相当大的医院间差异(中位数为1.6%，四分位数区间0.0%-3.1%），确定3个异常医院，其总体修订量明显高于预期（O/E范围1.9-2.3）和特定适应症（袖带病理和感染）。2014-2018年的结果相似。对于3年的修订，确定了3家离群医院(O/E范围1.7-3.3)。所有结果的排名都很低。
结论：主要SA后1年和3年的翻修率在医院之间观察到相当大的差异，在那里，可以根据修订的具体适应症的巨大差异来确定离群医院，以指导质量改进举措。然而,排名很低，这意味着许多其他(较小的)性能变化无法检测到，使修订不适合对主要SA后的医院表现进行排名。
