背景:英格兰的主要肘部置换(TER)服务正在进行重组,目的是将护理集中到专业中心。重要的是要监视此服务重新设计的影响。该方案概述了预期的分析,以提供接受主要TER的患者的详细描述,TER在哪里和由谁执行,以及在重新配置之前,TER的当前外科手术在英格兰是什么。
方法:此分析将使用国家联合登记(NJR)肘部数据集,并将其与NHS英格兰医院事件统计-入院患者护理(HES-APC)链接。它将包括从2012年4月NJR肘部数据集开始到2022年12月的合格患者。主要目的是确定TER在英格兰的发病率。将为包括不同种族在内的群体计算年龄-性别标准化率,和社会经济背景,使用国家统计局提供的年中人口数据。此计划分析将总结患者特征,如年龄、性别,体重指数(BMI),手支配,美国麻醉医师协会(ASA)等级,TER的指示,社会经济地位,和病人共病。它还将检查植入物固定类型,分类,品牌/类型,以及英格兰使用的植入物类型随时间的变化。此外,它将探讨提供初级TER服务的外科医生和医院的特点和数量,包括初级外科医生的等级,手术的资金来源,和录取类型。该分析将涵盖英格兰和英格兰每个地区每年由外科医生和医院执行的手术数量。最后,计划的分析将总结可选的等待时间,术后住院时间,以及任何严重不良事件或在TER后30和90天内重新入院。
结论:该方案描述了对NJR肘部数据集的首次深入分析,以描述英格兰TER手术的发生率和接受该手术的患者的特征。此分析将总结在服务重新配置之前英格兰当前的主要TER实践。可以通过将未来的实践与本研究的结果进行比较来监测重新配置的影响。试用注册ClinicalTrials.gov,NCT06355011。注册日期为2024年4月2日,https://clinicaltrials.gov/ct2/show/NCT06355011。
BACKGROUND: Primary total elbow
replacement (TER) services in England are being restructured with the goal of centralising care to specialised centres. It is important to monitor the impact of this service redesign. This protocol outlines an intended analysis to provide detailed descriptions of the patients who are receiving primary TER, where and by whom TER is being performed, and what the current surgical practices for TER are in England before the reconfiguration.
METHODS: This analysis will use the National Joint Registry (NJR) elbow dataset and link it with NHS England Hospital Episode Statistics-Admitted Patient Care (HES-APC). It will include eligible patients from the start of the NJR elbow dataset in April 2012 to December 2022. The main objective is to determine the incidence of TER in England. Age-sex standardised rates will be calculated for groups including different ethnicities, and socioeconomic backgrounds, using the mid-year population data provided by the Office for National Statistics. This planned analysis will summarise patient characteristics such as age, sex, body mass index (BMI), hand dominance, American Society of Anaesthesiologists (ASA) grade, indication for TER, socioeconomic status, and patient co-morbidities. It will also examine implant fixation type, classification, brand/type, and changes over time in implant types used in England. Additionally, it will explore the characteristics and volume of the surgeons and hospitals providing primary TER services, including the grade of the primary surgeons, funding source for surgery, and admission type. The analysis will cover the number of procedures performed by surgeons and hospitals annually in England and in each region of England. Finally, the planned analysis will summarise the elective wait time, postoperative length of stay, and any serious adverse events or re-admissions within 30 and 90 days after the TER.
CONCLUSIONS: This protocol describes the first deep dive analysis into the NJR elbow dataset to describe the incidence of TER surgery in England and the characteristics of patients who are receiving it. This analysis will summarise current primary TER practices in England before service reconfigurations. The impact of reconfiguration can be monitored by comparing future practice to the outcomes from this study. Trial registration ClinicalTrials.gov, NCT06355011. Registered 02 April 2024, https://clinicaltrials.gov/ct2/show/NCT06355011 .