40% of NHS Trusts and Health Boards ‘red’ rated for submissions to mandatory National Joint Registry
Local NHS Trusts and Health Boards could be putting the long-term safety
of patients at risk in failing to comply with the now-mandatory NJR.
The NJR records data on hip, knee, ankles, elbow and shoulder
replacements for England and Wales. Analysis of this information for all
patients provides clinical evidence to surgeons and the wider
healthcare community in order to protect patient safety and improve
patient care. With over 1.3 million records, the NJR is the largest
registry of its type in the world.
For the first time, today’s publication of the 9th NJR Annual Report
includes individual hospital data which reveals that 40% (59 out of 148)
of relevant NHS Trusts and Health Boards submitted between 0% and 79%
of the hip and knee replacement operations they performed in 2011 –
classifying them as ‘red’ in the NJR’s red, amber, green analysis
classification.
The Department of Health made NJR compliance mandatory as of 1 April
2011, and the figures above cover the period 1 January 2011 to 31
December 2011. But while the first three months of 2011 were
non-mandatory, during this time hospitals were strongly encouraged to
comply fully with the NJR.
NJR National Development Lead Elaine Young comments: “The data we
receive are essential for healthcare professionals in deciding which
prostheses and procedures are right for which patients at what time to
ensure patient safety. The fuller the picture provided by hospitals, the
more robust the data quality, which can only lead to further
improvements in patient care.”
Young continues: “The situation has improved since mandation and many
best practice examples exist. But, going forward, data from English NHS
Trusts and Welsh Health Boards failing to comply will be escalated to
the regulators, the Care Quality Commission and Welsh Government
respectively. We would encourage any hospital in need of support to
contact the NJR.”
The NJR is also for the first time issuing individual annual reports to
NHS Trusts, Health Boards and independent and private sector management
covering mortality by unit (individual hospital) and joint replacement
survivorship (how long a device lasts before it needs replacing or
modifying) by unit and surgeon.
Professor Paul Gregg, Vice Chair of the NJR Steering Committee and Chair
of its Surgeon Outlier Sub-committee added comments: “This will play a
vital role in improving patient safety and overall outcomes of joint
replacement surgery. However, the NJR relies on hospitals to help
maximise data quality - it is therefore highly disappointing that not
all Trusts and Health Boards are currently registering all operations as
this will have a negative effect on this process. If managers want a
precise picture of what is happening in their units, they must act now
and not wait until issues are escalated.”
Other indicators for the new Trust-, Health Board- and hospital-level
data analysis include patient consent and linkability as well as
mortality rates, hip revision and knee revision rates for the period
2003 (when the NJR began reporting) to 2011.
Hip joint replacement: key trends 2011
For hip replacements, the average body mass index (BMI) score for men
and women was ‘overweight’ and the score has consistently increased
within that category since 2004 but is consistently lower for women than
men. In the same period, the proportion of patients with a normal BMI
has fallen by 7%.
Correspondingly, the proportion of patients rated fit and healthy (P1 -
an ASA grade rating general health and fitness to undergo surgery)
decreased again to 15%, from 16% in 2010 and 37% in 2003.
Despite some anecdotal suggestion that hip replacement patients are
getting younger, NJR data describe a consistent age range of patients.
For example, patients under the age of 50 represent 6% of the total
which has not changed since 2003 and patients over the age of 80 remains
around 14%. The average age of a hip replacement patient was 67.2 –
unchanged from last year.
Key facts (hips)
* 80,314 hip replacement procedures were carried out – an increase of 5% over 2010 (76,759)
* 5% of this total represents resurfacing and metal-on-metal total hip replacement procedures, a decline from 2010 (8%)
* Patient age and gender unchanged: average age 67.2 years and 60% were female
* In 93% of patients, the indication for surgery was osteoarthritis
however in patients less than 30 years of age, 22% were recorded as
having diagnosis of congenital dislocation/dysplasia of the hip and 20%
of patients has a diagnosis of avascular necrosis
Knee joint replacement: key trends 2011
For knee replacements, the average BMI score was again ‘obese’ for men
and women – 30.82 up from 30.66 last year and with year-on-year increase
since the average reached ‘obese’ in 2008. Women have scored a
consistently higher BMI since 2004, the opposite trend to that shown for
hip replacements. Again, the proportion of patients rated fit and
healthy prior to knee replacement surgery has fallen by 1% from 12% in
2010 and since 2003, a decline from 31%.
Key facts (knees)
* 84,653 knee replacement procedures carried out – an increase of 3.3% over 2010 (81,959)
* Patient age and gender was largely unchanged: average age was 67.4 and 56% were female
* In 98% of patients, the indication recorded for surgery was osteoarthritis
Ankle joint replacement: key facts
* Ankle replacements have been recorded on the NJR since April 2010
* 492 ankle replacements were recorded and compliance rate overall for
this type of joint replacement is 64% (358 were recorded in 2010)
* Diagnosis was recorded as osteoarthritis in 88% of cases and of these,
19% had a previous history of fracture and hence post-traumatic
osteoarthritis
* 75% of procedures were carried out in the NHS sector
* 56% of patients were male and average age of patients was 68 years old
* The average BMI score was overweight, a higher score than hip
replacement procedures but lower than the obese score for knee
procedures
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