Abstract
Aim:
To describe total elbow replacement (TER) procedures in England, including incidence, patient profiles, implant types, outcomes, and TER service provider characteristics.
Methods:
Analysis of primary TERs on the National Joint Registry (NJR) from April 2012 to December 2022 with mortality data from the Civil Registration of Deaths dataset. Linkage with Hospital Episode Statistics-Admitted Patient Care (HES-APC) data provided additional patient data not collected by the NJR. Incidence rates were calculated using population estimates from the Office for National Statistics. The annual number of procedures performed by surgeons and hospitals were analysed on a national and regional basis.
Results:
3,891 primary TERs were included. The annual incidence of TER was 0.72-0.82 per 100,000 persons before 2020 and declined to 0.4 due to a decrease in elective TERs because of the COVID-19 pandemic, with a slight recovery in 2022. Older age groups, white ethnic groups and females were more likely to undergo TER surgery. Elective patients had to wait for a median of 89-122 days in years before 2020, which increased to 183 days in 2020. The number of TERs performed by surgeons per annum remained unchanged, with a median of two. The median annual number of TERs per region is three-to-six times higher than the median annual case load of the highest volume hospital in a region. Patients in the lowest socioeconomic group had a higher rate of serious adverse events and mortality (11%) when undergoing surgery for acute trauma.
Conclusions:
TER is more common in older age groups, females, and white ethnic groups in England. COVID-19 impacted elective TER rates and waiting times, and TER services have not recovered yet. The GIRFT recommendation of centralising services to one hub per region could result in up to a six-fold increase in the number of TERs in some hub hospitals.
To describe total elbow replacement (TER) procedures in England, including incidence, patient profiles, implant types, outcomes, and TER service provider characteristics.
Methods:
Analysis of primary TERs on the National Joint Registry (NJR) from April 2012 to December 2022 with mortality data from the Civil Registration of Deaths dataset. Linkage with Hospital Episode Statistics-Admitted Patient Care (HES-APC) data provided additional patient data not collected by the NJR. Incidence rates were calculated using population estimates from the Office for National Statistics. The annual number of procedures performed by surgeons and hospitals were analysed on a national and regional basis.
Results:
3,891 primary TERs were included. The annual incidence of TER was 0.72-0.82 per 100,000 persons before 2020 and declined to 0.4 due to a decrease in elective TERs because of the COVID-19 pandemic, with a slight recovery in 2022. Older age groups, white ethnic groups and females were more likely to undergo TER surgery. Elective patients had to wait for a median of 89-122 days in years before 2020, which increased to 183 days in 2020. The number of TERs performed by surgeons per annum remained unchanged, with a median of two. The median annual number of TERs per region is three-to-six times higher than the median annual case load of the highest volume hospital in a region. Patients in the lowest socioeconomic group had a higher rate of serious adverse events and mortality (11%) when undergoing surgery for acute trauma.
Conclusions:
TER is more common in older age groups, females, and white ethnic groups in England. COVID-19 impacted elective TER rates and waiting times, and TER services have not recovered yet. The GIRFT recommendation of centralising services to one hub per region could result in up to a six-fold increase in the number of TERs in some hub hospitals.
| Original language | English |
|---|---|
| Journal | Bone and Joint Journal |
| Publication status | Accepted/In press - 22 Jul 2024 |
Keywords
- accuracy
- Arthroplasty
- Completeness
- Data quality
- Elbow
- replacement