Registration rate in the Norwegian Cruciate Ligament Register: large-volume hospitals perform better.

BACKGROUND AND PURPOSE: The Norwegian Cruciate Ligament Register (NCLR) was founded in 2004. The purpose of the NCLR is to provide representative and reliable data for future research. In this study we evaluated the development of the registration rate in the NCLR. METHODS: The Norwegian Patient Register (NPR) and the electronic patient charts (EPCs) were used as reference data for public and private hospitals, respectively. Data were retrieved for all primary and revision anterior cruciate ligament (ACL) surgery during 2008-2009 in public hospitals and during 2008 in private hospitals. The NOMESCO classification of surgical procedures was used for identification of ACL surgeries. Public hospitals were divided into subgroups according to the annual number of operations in the NPR: small hospitals (< 30 operations) and large hospitals (≥ 30 operations). RESULTS: For the 2-year data extracted from public hospitals, 2,781 and 2,393 operations met the inclusion criteria according to the NPR and the NCLR, respectively, giving an average registration rate of 86% (95% CI: 0.85-0.87). The registration rate for small public hospitals was 69% (CI: 0.65-0.73), which was significantly less than for large public hospitals (89%, CI: 0.88-0.90; p < 0.001). In 2008, private hospitals reported 548 operations to the NCLR while 637 were found in the EPCs, giving a registration rate of 86% (CI: 0.83-0.89). In that year, the registration rate for public hospitals was 86%, which was similar to that for private hospitals. INTERPRETATION: The NCLR registration rate for the period 2008-09 was similar in both 2008 and 2009, and is satisfactory for research. There is room for improvement of registration rates, particularly in hospitals with a small volume of ACL operations.

The Norwegian Hip Fracture Register: experiences after the first 2 years and 15,576 reported operations.

BACKGROUND AND PURPOSE: The Norwegian Hip Fracture Register was established in January 2005 to collect nationwide information as a basis for improved management of patients with hip fractures. We now report our experience after the first 2 years. METHODS: After both primary operations and reoperations, the surgeons fill in a standardized 1-page form with information about the patient, the fracture, and the operation. Fractures treated with a total hip arthroplasty are reported to the national arthroplasty register, but are added to the hip fracture register before analyses are performed. 4, 12, and 36 months postoperatively, a standardized questionnaire including health-related quality of life (EQ-5D), visual analog scales concerning pain and patient satisfaction, and Charnley class for functional assessment is sent directly from the register to the patients. To evaluate the completeness of registration, our data were compared with data from the Norwegian Patient Registry (NPR). RESULTS: During the first year of registration, all 55 hospitals treating hip fractures in Norway started to report their hip fracture operations. During 2005, the monthly reporting increased and it stabilized in 2006. 13,251 primary-operated hips (mean age of patients: 80 years; 72% females) and 2,325 reoperations were reported during 2005 and 2006. Compared to the NPR, the completeness of registration was 64% in 2005 and 79% in 2006. 58% of the patients who were alive answered the 4-month questionnaire. The non-responders were older, were more often cognitively impaired, and had a higher degree of comorbidity than the responders. Undisplaced femoral neck fractures (19% of all fractures) were almost exclusively operated with screw osteosynthesis (95%). Dislocated femoral neck fractures (38% of all fractures) were operated with a hemiarthroplasty in 52% of the cases. Osteosynthesis with a hip compression screw was the predominant operation method for trochanteric fractures (81%). INTERPRETATION: After only 2 years, our nationwide system for surveillance of demographics, treatment, and outcome of hip fractures is functioning well. As expected, the response rate for the 4-month questionnaires was relatively low due to the old population with high comorbidity and cognitive impairment. The different treatment methods used for patients in the same groups of fracture types show that there is still no consensus in Norway regarding the treatment of hip fractures.

Development of a national cruciate ligament surgery registry: the Norwegian National Knee Ligament Registry.

BACKGROUND: No prospective surveillance system exists for monitoring the outcome of cruciate ligament surgery. PURPOSE: This article is intended to describe the development and procedures of the Norwegian National Knee Ligament Registry (NKLR), including baseline results from the first 2 years of operation. STUDY DESIGN: Cohort study (prevalence); Level of evidence, 1. METHODS: The NKLR was established on June 7, 2004 to collect information prospectively on all cases of cruciate ligament reconstruction surgery in Norway. Information on the details of surgery is gathered through a registration form completed by the surgeon postoperatively, and a validated knee outcome score form is completed by the patients preoperatively and at follow-ups on all patients at 2, 5, and 10 years postoperatively. Hospital compliance was examined in 2005 and 2006. RESULTS: A total of 2793 primary cruciate ligament reconstruction surgeries were registered by 57 hospitals. This corresponds to an annual population incidence of primary anterior cruciate ligament reconstruction surgeries of 34 per 100,000 citizens (85 per 100 000 citizens in the main at-risk age group of 16-39 years). After 21 months of operation, the NKLR had an overall compliance of 97% when compared with the hospital records. CONCLUSIONS: A national population-based cruciate ligament registry has been developed, implemented, and maintained in Norway. The registry will each year enroll approximately 1500 primary cruciate ligament reconstruction cases. It is expected that inadequate procedures and devices can be identified, as well as prognostic factors associated with good and poor outcomes, at least for the most frequent categories.