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Published on: February 27, 2018
Monitoring surgical performance: an application to total hip replacement
David J Biau1, Alexandre Milet, Fabrice Thévenin
1Département de chirurgie orthopédique, Hôpital Cochin, AP-HP, Université Paris 5, France. djmbiau@yahoo.fr
Insights
Monitoring hip replacement surgery in a teaching hospital revealed significant quality issues. Implementing a dedicated system improved performance, though the 90% adequate target for total hip replacements was not met.
Area of Science:
- Orthopedic Surgery
- Surgical Quality Improvement
- Medical Device Performance
Background:
- Inadequate hip replacement surgery can lead to poor patient outcomes and reduced implant longevity.
- Effective monitoring of surgical performance is crucial for ensuring high-quality hip replacement procedures.
Purpose of the Study:
- To implement and evaluate a system for monitoring surgical performance in total hip replacement procedures.
- To identify factors contributing to inadequate hip implantations and improve patient satisfaction.
Main Methods:
- Prospective monitoring of primary total hip replacements at a teaching center.
- Recording intraoperative technical errors, implant fixation, and postoperative complications.
- Utilizing the Cumulative Sums (CUSUM) test to track center performance against defined adequacy thresholds (90% adequate, 75% inadequate).
Main Results:
- Out of 83 total hip replacements, 34% were deemed inadequate, primarily due to issues with cup positioning and stem fixation.
- The CUSUM test indicated inadequate performance early in the monitoring period.
- Despite initial improvements and discussions, the study was halted before demonstrating sustained adequate performance.
Conclusions:
- A dedicated monitoring system can enhance the quality of total hip replacement surgery in teaching hospitals.
- Continuous efforts are needed to achieve the target of 90% adequate primary total hip replacements.
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.