KP Orthopedic Implant Registries Dale Daniel January 2012 Overview Collaborations AAOS 2012 KPHC update Registry updates Total Joint ACL Spine Shoulder Replacement Hip Fracture 2 Collaborations Norway Registry Collaboration International Consortium of Orthopedic Registries JBJS Supplement 6 articles 3 TJR projects FDA Collaboration Mobile versus fixed TKAs THA bearing surface Data Extraction and Longitudinal Time Analysis (DELTA) AHRQ imputation strategies 3
AAOS 2012: 9 Abstracts Podium Presentations Namba R, Inacio M, Paxton. Factors Associated with Infection in 30, 491 Primary Total Hip Arthroplasty Cases. Namba R, Inacio M, Paxton. Factors Associated with Deep Infection in 56,216 Primary Total Knee Arthroplasties. Maletis G, Inacio M, Desmond J, Funahashi T. Influence of ACL Graft Choice on the Likelihood of Early Revision ACL Reconstruction. Singh A, Burke M. The Effect of Surgical Volume on Shoulder Arthroplasty Quality Metrics. Bini S.A., Chen Y., Khatod M., Paxton E.W. The Effect of Patient Specific Factors on Revision Rates for Unicompartmental Knee Arthroplasty. Posters Bini S.A., Chen Y., Khatod M., Paxton E.W. Surgeon Experience is Not Predictive of Implant Survivorship in 1,784 Unicompartmental Knees. Dillon M, Burke M, Takayanagi M, Navarro R, Yian E. Shoulder Arthroplasty in Patients 59 Years of Age and Younger. Khatod M., Ake C., Paxton E.W., Wang C., Sedrakyan A. A Comparison of Metal on Metal to Metal on Highly Cross-linked Polyethylene Total Hip replacements. Navarro R, Inacio M, Burke M, Costouros J,Yian E. Effect of Traumatic Indication and Implant Type on Symptomatic VTE Rates in Shoulder Arthroplasty. 4 AAOS KP Ortho Registry Reception Friday, February 10, 2012, 6-8 pm Parc 55 55 Cyril Magnin St. 5 KPHC IT Update SmartForms Live in SCAL!! Operative KPHC forms next 6
Total Joint Registry Largest in U.S. > 136,000 7 Total Joint Registry Participation- knee 8 Infection Risk Calculator: Knee http://implantregistries.kp.org/registries/risk_calculator.htm 9
Patient Reported Outcomes Hip: https://www.mykpvoice.org/r.aspx?a=273&t=1 Knee: https://www.mykpvoice.org/r.aspx?a=276&t=1 VR-12, VAS, UCLA Activity Index, HOOS/KOOS Pre-op and 6, 12, and 24 months postop Downey, Orange County, Fresno, Oakland 10 Surgeon Profiles 11 Total Joint Registry Quarterly Quality Report: Region & Medical Center SPC charts for Infections, DVT,PEs, LOS, readmission & revision rates 12
TJRR Publications 2011 Inacio M, Paxton E, Chen Y, Harris J, Eck E, Barnes S, Namba R, Ake C. Leveraging Electronic Medical Records in the Surveillance of Surgical Site Infections in a Total Joint Replacement Population. Infection Control and Hospital Epidemiology. 2011 April; 32 (4). Khatod M, Bini S, Inacio M, Paxton E. Prophylaxis Against Pulmonary Embolism in Patients Undergoing Total Hip Arthroplasty. The Journal of Bone and Joint Surgery. 2011 Oct; 93-(19). Khatod M, Inacio M, Bini S, Paxton E. Pulmonary Embolism Prophylaxis in over 30,000 Total Knee Patients: Is there a best choice? The Journal of Arthroplasty. 2011 Jun 3. Namba R, Inacio M, Paxton E, Robertsson O, Grave S. The Role of Registry Data in the Evaluation of Mobile Bearing Total Knee Arthroplasty. The Journal of Bone and Joint Surgery. Accepted August 2011. Paxton E, Ake C, Inacio M, Khatod M, Marinac-Dabic D, Sedrakyan A. Evaluation of Total Hip Arthroplasty Devices Using a Total Joint Replacement Registry. Pharmacoepidemiology and Drug Safety. Submitted August 2011. Paxton E, Furnes O, Inacio M, Fenstad A, Namba R, Havelin L. Comparison of the Norwegian Knee Arthroplasty Register and a United States Arthroplasty Registry. The Journal of Bone and Joint Surgery. Submitted July 2011. Robertsson O, Mendenhall S, Paxton E, Inacio M, Graves S. Challenges in Prosthesis Classification. The Journal of Bone and Joint Surgery. Accepted August 2011 13 ACLR Registry Over 16,000 ACLRs Registered LARGEST in U.S. 14 ACLR Registry, cont d Patient Reported Outcomes: Knee Osteoarthritis Outcome Score Pre-op and 1, 2, and 5 year post-op at Baldwin Park, San Diego, Orange County since April 2010 Overall >80% pre-op response rate in clinic 43% overall post-op response rate including clinic, snail mail (<40%), & email (50%) Attrition Survey 2,277 (~17%) patients in the ACLRR who are no longer KP members Short questionnaire developed to determine if these patients have had a revision or re operation since leaving KP Email, snail mail, phone survey 15
ACLRR Publications 2011 Chadia A, et al. Are Meniscus and Cartilage Injury Related to Time to Anterior Cruciate Ligament Reconstruction? American Journal of Sports Medicine. 2011 September; 39 (9):1894-1899. Inacio M, et al. Patient and Surgeon Characteristics Associated with Primary Anterior Cruciate Ligament Reconstruction Graft Selection. American Journal of Sports Medicine. Accepted for publication August 2011. Maletis G, Granan LP, Inacio M, Funahashi T, Engebretsen L. Comparison of a Community Based Anterior Cruciate Ligament Reconstruction Registry in the United States and Norway. The Journal of Bone and Joint Surgery. Accepted July 2011. Csintalan R, et al. Risk of Revision and Re-operation in Patients Undergoing ACLR Reconstruction with Open Physis. American Journal of Sports Medicine. Submitted October 2011. 16 Spine Registry Update Scope: To capture all spinal cases that implant BMP, pedicle screws, anterior cervical plates and/or total disc replacement using Optime data Participating Regions: SCAL, NCAL, HI, NW Volume: 9,611 cases Next Steps: Identify post-op complications Capture level of spine, diagnosis, and procedure on all cases Further clarification of implant usage by medical center and region Identify local medical center leads 17 Shoulder Arthroplasty Registry 6,527 cases registered (2005 thru Q3 2011) Registry includes traumatic and elective cases Preop/Status SmartForm building initiated IRB pending for MAS, OH, and NW Effect of Traumatic Indication and Implant Type on Symptomatic VTE Rates in Shoulder Arthroplasty poster at European Society for Surgery of the Shoulder and the Elbow Congress Sept 2011 18
Shoulder Arthroplasty Registry Q2 2011 Final Participation - PreOp 19 Shoulder Arthroplasty Registry Q2 2011 Final Participation - Operative 20 Hip Fracture Registry Data Source: Clarity, Claims NCAL, SCAL, CO, HI, OH, NW, MAS 12,614 cases Demographics, fracture type, fixation type, diagnosis, procedure (ICD-9, CPT-4) and outcomes Centralized x-ray review and Orthopedic Trauma Association (OTA) Proximal Femur Classification algorithm Quarterly infection control reports to begin Q1 2012 21
Areas of Focus for 2012 Translating registry findings into clinical practice Quality reporting and monitoring Enhance & expand risk calculators Patient optimization KP Implant Registries Symposium Sept 15 th Huntington Beach Hyatt 22 Contact Information Surgical Outcomes and Analysis 3033 Bunker Hill St. Basement Level San Diego, CA 92109 Main Office: (858) 581-8272 Fax: (858) 581-8276 Tie-line: 290 Email: implantregistries@kp.org 23