Institutional arthroplasty registry: what is the minimum acceptable dataset to be included in your hospital? Recommendations from a single-country national consensus using the Delphi method.

PURPOSE: Institutional arthroplasty registries are very popular nowadays; however, very few efforts have been made in order to standardize the information to be collected, thus limiting the possibility of inter-institutional data interpretation. This manuscript reports the results of a single-country consensus designed to define the minimum standardized dataset to be recorded within an institutional arthroplasty registry. METHODS: A national consensus was carried out among all members of the Colombian Society of Hip and Knee Surgeons using the Delphi method. Eleven questions and answers comprising every potential domain of an institutional registry of hip and knee arthroplasty were defined. According to the methodology, anonymous voting and multiple discussion rounds were performed. Three levels of agreement were defined: Strong consensus: equal to or greater than 80%, weak consensus between 70 and 79.9%, and no consensus below 70%. RESULTS: All of the questions reached consensus level. The minimum dataset was defined to include demographic and clinical information, intraoperative and implant details, follow-up and early complications, implant survival, and functional outcome scores, as well as the validation model to assess information quality within the database. Currently, this dataset is being implemented voluntarily by the members of our national society. DISCUSSION: A national consensus is a feasible method to build homogeneous arthroplasty registries. We recommend such an exercise since it establishes the basis to compare and add data between institutions and the joint analysis of said information in a national registry.

A multimodal approach prevents instability after total hip arthroplasty: A 1 year follow-up prospective study.

INTRODUCTION: Joint dislocation is one of the most frequent complications after hip arthroplasty. Multiple strategies have demonstrated ability to prevent instability when used in isolation, but the effect when more than one intervention is implemented has not been measured. The purpose of this study is to assess the rate of dislocation after implementation of a protocol of combined strategies for prevention of instability. MATERIALS AND METHODS: Consecutive patients undergoing primary total hip replacement for hip osteoarthritis between February 2012 and June 2014 were included. A multimodal protocol including patient education, use of large femoral heads, posterior soft-tissue repair, and intraoperative adjustment of limb length and hip offset was applied. Dislocation episodes were documented trough medical records review and a telephonic follow-up at 3 and 12 months after surgery. RESULTS: During the period of study 331 patients were included, mean age was 66 years and 68.8% were females. Only 0.91% of patients were lost to follow-up. Eighty-nine percent of patients received all interventions. Cumulative dislocation rate at 3 months was 0.60% and 0.90% at 12 months. CONCLUSIONS: The implementation of a multimodal protocol for prevention of prosthesis instability produces a low rate of dislocation, which compares favorably with benchmarks. We recommend the use of a combination of multiple interventions to prevent this complication.

Análisis epidemiológico de las causas de consultas más frecuentes en un servicio de urgencia de un hospital tipo cuatro / Epidemiologic analysis of more frequent causes of consultation at an emergency service of a type 4 hospital

El hospital de Chimbarongo es un hospital tipo 4 que atiende una población de 32943 habitantes, en su mayoría rural (62 por ciento). El objetivo de este análisis epidemiológico es determinar las causas de consultas más frecuentes en el servicio de urgencia, describir, entre éstas, la más frecuente (enfermedades respiratorias) en base a factores biológicos, geográficos y de patología; asimismo, mostrar la importancia del servicio de urgencia como puerta de acceso a la atención en salud. El 60 por ciento de las consultas corresponden a uno de estos grupos de patologías: respiratorio, traumatismos y envenenamientos o enfermedades infecciosas, siendo la primera la más frecuente. En las enfermedades respiratorias el 65 por ciento de las consultas son por población infantil, de origen rural en un 45 por ciento; las infecciones respiratorias bajas representan el 17 por ciento de este grupo, siendo ésta la principal causa de hospitalización en edades extremas. Se concluye que el servicio de urgencia es un eficiente sistema de acceso a la atención de salud y adecuado filtro para enfermedades y grupos de riesgo