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Using population data to measure outcomes of care: The case of hip and knee replacements

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by Claudia Sanmartin, Kimberlyn McGrail, Mike Dunbar and Eric Bohm

Abstract
Keywords
Findings
Authors
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Abstract

Background

Accumulating evidence points to overall improvements in health-related quality of life  after joint replacement for osteoarthritis.  Some patients, however, do not appear to benefit from joint replacement.  This study investigates health outcomes of patients who underwent hip or knee replacement surgery.

Methods

Linked survey and administrative data were used to compare the health-related quality of life of individuals who underwent surgery (surgical group) with that of their contemporaries who did not (comparison group), adjusting for other determinants of health.  Weighted multivariate linear regression analyses were conducted. 

Results

When the results were adjusted for other covariates known to be associated with health, the surgical group reported lower functional health (post-operative) than did the comparison group.  Differences ranged from 6% lower functional health among hip replacement patients diagnosed with osteoarthritis to 21% lower functional health for those with hip fractures.  Among surgical patients with osteoarthritis, co-morbid conditions and being underweight were associated with lower post-operative functional health.

Interpretation

This study is a unique application of linked data to the study of health outcomes of joint replacement at the population level.  Outcomes of joint replacement differed by the initial diagnosis or reason for the surgery.  For patients with osteoarthritis, poorer post-operative health outcomes were associated with co-morbidites and with being underweight.

Keywords

arthroplasty, databases, data collection, health status, hip fractures, hospital records, osteoarthritis

Findings

Joint (hip and knee) replacement can provide substantial relief to people suffering from pain and limited mobility. In Canada, approximately 23,000 hip replacements and 38,400 knee replacements were conducted in 2006/2007. The rate at which these procedures were performed more than doubled between 1995/1996 and 2005/2006, with even sharper increases between 2004/2005 and 2006/2007. The rising rate is partially a refl ection of an aging population; the recent acceleration is likely related to the identifi cation of joint replacement among the fi ve priority areas selected for meaningful reductions in waiting times.[Full text]

Authors

Claudia Sanmartin (613-951-6059; Claudia.Sanmartin@statcan.ca) is with the Health Analysis Division at Statistics Canada in Ottawa, Ontario K1A 0T6; Kimberlyn McGrail is with the Health Analysis Division and the University of British Columbia; Mike Dunbar is with Dalhousie University; and Eric Bohm is with the University of Manitoba Joint Replacement Group.