Rates & Predictors of Failures of Total Hip Replacement:Population Based Study

价格

• 批准号: 7578200
• 负责人: Jeffrey Neil Katz
• 金额: $ 39.5万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-01 至 2012-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7578200
• 关键词: Affect; American Hospital Association; Arthritis; Body Weight; Case-Control Studies; Censuses; Characteristics; Clinical; Complex; Complication; Data; Databases; Demographic Factors; Ensure; Epidemiologist; Failure; Habits; Health; Hip Osteoarthritis; Hip region structure; Hospital Costs; Hospitals; Implant; Incidence; Intervention; Longevity; Medical Records; Medicare; Minority; Minority Groups; Neighborhoods; Nested Case-Control Study; Numbers; Operative Surgical Procedures; Orthopedics; Outcome; Pain; Patient Care; Patients; Persons; Policies; Population; Population Replacements; Poverty; Procedures; Prosthesis; Prosthesis Failure; Qualifying; Quality of life; Rate; Registries; Reporting; Research; Research Design; Resources; Risk; Risk Estimate; Risk Factors; Sampling; Source; Surgeon; Testing; Total Hip Replacement; Work; base; beneficiary; cohort; cost; disability; experience; functional status; indexing; male; modifiable risk; mortality; sex; socioeconomics; stem

Osteoarthritis of the hip affects over four million persons in the US and results in over 200,000 primary elective total hip replacements (THR) per year. Failure of the prosthesis is costly and disabling, resulting in 37,000 revision hip replacements annually in the US. Although increasing evidence points to a growing burden of revision total hip replacements over the next decade - with attendant complications, disability and costs - US population based rates of THR failure have not been determined. Further, there are no US population based studies of risk factors for THR failure. All data have been reported from referral centers, where a minority of THR's is performed. These observations highlight the urgent need for population-based studies of the rate of failure leading to revision THR and to identify risk factors, especially those that are modifiable. This proposal builds upon the extensive experience of the research team in population-based studies of the utilization and outcomes of THR in the US Medicare population. In previous work we assembled a claims-based cohort of 58,000 Medicare beneficiaries who had elective THR between July 1995 and June 1996. In this application we propose to follow this cohort for twelve years following the index THR to undertake the following specific aims: 1) To perform a nested case control study in order to identify factors associated with prosthesis failure leading to revision following elective primary THR. Risk factors will be ascertained from medical records, Medicare claims, Census data and American Hospital Association data. 2) To estimate the cumulative incidence rate of prosthesis failure leading to revision THR over twelve years in a national population-based cohort of Medicare beneficiaries, and to identify factors associated with prosthesis failure in the national claims cohort. The findings will provide a national estimate of the risk of THR failure and an assessment of factors associated with THR failure at a national level. We investigate risk factors at the patient, surgeon and hospital level, permitting inferences that will guide clinical and policy interventions at several levels. These data will permit clinicians to better inform patients about the anticipated longevity of their implants and about factors that may influence prosthesis survival, and consequently the patient's quality of life. Lay Summary: Total hip replacement is done frequently for severe arthritis of the hip. There is very little information available at a national level on how long the implants work properly until they cause pain and need to be replaced. This study uses information from Medicare claims and medical records to determine the risk of failure of the hip replacement and the factors that predict which patients will experience a failure.

臀部的骨关节炎影响了美国超过400万人，并导致超过200,000个主要的人 每年选择性髋关节置换（THR）。假体的失败是昂贵且残疾的，导致 在美国，每年37,000个修订髋关节替换。尽管增加了证据表明增长 修订的负担在接下来的十年中，总髋关节置换术 - 随之而来的并发症，残疾和 成本 - 尚未确定基于美国的THR失败率。此外，没有我们 基于人群的THR失败风险因素的研究。所有数据均已从转介中心报告， 执行少数THR的地方。这些观察结果凸显了迫切需要基于人群的 研究导致修订的失败率并确定风险因素，尤其是那些危险因素 可修改。该建议基于研究团队在基于人群的广泛经验的基础上 美国医疗保险人口中THR的利用率和结果的研究。在以前的工作中 组装了一个基于索赔的队列，由58,000名Medicare受益人组成，他们在7月之间进行了选择 1995年和1996年6月。在此申请中，我们建议在该指数之后遵循该队列十二年 实现以下特定目标： 1）进行嵌套的案例控制研究以识别与假体相关的因素 选修初级THR之后导致修订的失败。风险因素将从 医疗记录，医疗保险索赔，人口普查数据和美国医院协会数据。 2）估计假体失败的累积发生率，导致修订超过十二 多年在国家人口的医疗保险受益人队中，并确定因素 与国家主张队列中的假体失败有关。 这些发现将提供有关THR失败风险和因素的评估的国家估计 与国家一级的THR失败有关。我们调查患者，外科医生和 医院水平，允许推论，以指导多个级别的临床和政策干预措施。这些 数据将使临床医生能够更好地告知患者植入物的预期寿命 可能影响假体生存的因素，从而影响患者的生活质量。 摘要摘要：总髋关节置换经常用于严重的髋关节炎。很少 在全国范围内获得的信息，涉及植入物的正常工作时间，直到引起疼痛和 需要更换。本研究使用Medicare索赔和病历中的信息来确定 髋关节置换失败的风险以及预测哪些患者会失败的因素。