Evidence map›Paper›PMID 28729306›Full record

ArticleBMJ open2017

Hospital variation in allogeneic transfusion and extended length of stay in primary elective hip and knee arthroplasty: a cross-sectional study.

Veronique M A Voorn, Perla J Marang-van de Mheen, Anja van der Hout, Cynthia So-Osman, M Elske van den Akker-van Marle, Ankie W M M Koopman-van Gemert, Albert Dahan, Thea P M Vliet Vlieland, Rob G H H Nelissen, Leti van Bodegom-Vos and 1 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

11 authors.

Veronique M A VoornDepartment of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
Perla J Marang-van de MheenDepartment of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
Anja van der HoutDepartment of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
Cynthia So-OsmanDepartment of Transfusion Medicine, Sanquin Blood Supply, Leiden, The Netherlands.
M Elske van den Akker-van MarleDepartment of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
Ankie W M M Koopman-van GemertDepartment of Anesthesiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
Albert DahanDepartment of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands.
Thea P M Vliet VlielandDepartment of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands.
Rob G H H NelissenDepartment of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands.
Leti van Bodegom-VosDepartment of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
LISBOA study group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesOutcomes in total hip and knee arthroplasty (THA and TKA), such as allogeneic transfusions or extended length of stay (LoS), can be used to compare the performance of hospitals. However, there is much variation in these outcomes. This study aims to rank hospitals and to assess hospital differences of two outcomes in THA and TKA: allogeneic transfusions and extended LoS, and to additionally identify factors associated with these differences.

designCross-sectional medical record review study.

settingData were gathered in 23 Dutch hospitals.

participants1163 THA and 986 TKA patient admissions. OUTCOMES: Hospitals were ranked based on their observed/expected (O/E) ratios regarding allogeneic transfusion and extended LoS percentages (extended LoS was defined by postoperative stay >4 days). To assess the reliability of these rankings, we calculated which percentage of the existing variation was based on differences between hospitals as compared with random variation (after adjustment for variation in patient characteristics). Associations between hospital-specific factors and O/E ratios were used to explore potential sources of differences.

resultsThe variation in O/E ratios between hospitals ranged from 0 to 4.4 for allogeneic transfusion, and from 0.08 to 2.7 for extended LoS. Variation in transfusion could in 21% be explained by hospital differences in THA and 34% in TKA. For extended LoS this was 71% in THA and 78% in TKA. Better performance (low O/E ratios) in transfusion was associated with more frequent tranexamic acid (TXA) use in TKA (R=-0.43, p=0.04). Better performance in extended LoS was associated with more frequent TXA use in THA (R=-0.45, p=0.03) and TKA (R=-0.65, p<0.001) and local infiltration analgesia (LIA) in TKA (R=-0.60, p=0.002).

conclusionsRanking hospitals based on allogeneic transfusion is unreliable due to small percentages of variation explained by hospital differences. Ranking based on extended LoS is more reliable. Hospitals using TXA and LIA have relatively fewer patients with transfusions and extended LoS.

Indexed as

Arthroplasty, Replacement, HipArthroplasty, Replacement, KneeAgedBlood TransfusionCross-Sectional StudiesElective Surgical ProceduresFemaleHospitalsHumansLength of StayLogistic ModelsMaleMiddle AgedMultivariate AnalysisNetherlandsPostoperative PeriodTranexamic AcidChange managementHipKneeOrthopaedic and Trauma Surgery

Identifiers

PMID28729306
PMCPMC5541495

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.