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Validation of reoperations due to infection in the Swedish Hip Arthroplasty Register
J Viktor Lindgren1, Max Gordon, Per Wretenberg
1Department of Molecular Medicine and Surgery, Section of Orthopaedics, Karolinska Institutet, Stockholm, Sweden. viktor.lindgren@karolinska.se.
Insights
The Swedish Hip Arthroplasty Register (SHAR) shows only 67% completeness for reoperations due to infection after total hip replacement (THR). This low completeness raises concerns about using SHAR data to assess infection rates accurately.
Area of Science:
- Orthopedic surgery
- Arthroplasty registry data validation
- Infection surveillance in joint replacements
Background:
- Accurate recording of reoperations is critical for interpreting arthroplasty register data.
- The completeness of infection-related reoperation data in the Swedish Hip Arthroplasty Register (SHAR) is currently unknown.
- This study aimed to validate SHAR reoperation data using external data sources.
Purpose of the Study:
- To assess the completeness of reoperation recordings due to infection in the Swedish Hip Arthroplasty Register (SHAR).
- To validate the accuracy of infection-related reoperation data within the SHAR.
- To determine the reliability of SHAR data for evaluating postoperative infection rates after total hip replacement (THR).
Main Methods:
- Utilized data from the Swedish Prescribed Drug Register (SPDR) and medical record reviews.
- Selected patients who underwent primary Total Hip Replacement (THR) between July 1, 2005, and December 31, 2008 (45,531 patients).
- Identified THRs with at least 4 weeks of continuous antibiotic treatment within 2 years post-surgery for detailed medical record review.
Main Results:
- A total of 599 (1.3%) THRs required reoperation within 2 years.
- Of these reoperations, 47.4% involved prosthesis revision or extraction.
- Only 400 THRs were registered as reoperations in the SHAR, yielding a completeness rate of 67%.
Conclusions:
- The completeness of recorded early infections after THR in the SHAR is suboptimal.
- The current data completeness raises doubts about the reliability of SHAR reoperation data for evaluating changes in postoperative infection rates.
- Further improvements in data capture are needed for accurate assessment of infection trends in hip arthroplasty.
Background:
Complete or almost complete recording of reoperations is essential to enable a correct interpretation of data in arthroplasty registers. The completeness of recordings due to infection is unknown in the Swedish Hip Arthroplasty Register (SHAR). We therefore used a combination of data from the Swedish Prescribed Drug Register (SPDR) and studies of medical records to validate the data of reoperations due to infection in the SHAR.
Methods:
All patients registered for a primary Total Hip Replacement (THR) in the SHAR between July 1, 2005 and December 31, 2008 were selected for the study (45,531 patients with 49,219 THRs) and were matched with the SPDR. All patients with a minimum of 4 weeks of continuous outpatient antibiotic treatment within 2 years after their primary THR (1,989 patients, with 2,219 THRs) were selected for a medical records review to find the THRs reoperated due to infection.
Results:
599 (1.3%) of the THRs had been reoperated within 2 years after the index operation and in 47.4% of these the prosthesis had been revised or extracted. 400 of the THRs were registered for a reoperation in the SHAR resulting in a completeness of 67%.
Conclusions:
The completeness of registration due to early infection after THR questions whether the SHAR reoperation data can be used in order to evaluate changes in postoperative infection rates.