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2,000+ joint replacement surgeon profiles published

28 October 2014: Joint statement from the National Joint Registry and British Orthopaedic Association

Information on 2,094 joint replacement surgeons carrying out orthopaedic surgery for the NHS in England have been published at www.njrsurgeonhospitalprofile.org.uk today.

The data, the second annual round of publication, are collected and presented by the National Joint Registry (NJR). Around 500 additional surgeons are covered this year for the first time as surgeons carrying out ankle, elbow and shoulder joint replacement surgery are now included alongside hip and knee surgeons.

Orthopaedics is the largest of thirteen surgical and medical specialities launching outcome information this year as part of NHS England’s continued transparency commitments.

The published surgeon profiles cover:

  • hospitals where a Consultant in charge works
  • number of primary and revision joint* replacement procedures undertaken and overseen by each Consultant in charge over 1 and 3 years (where possible)
  • mortality within 90 days of surgery for hip and knee replacements (2003-2014)**
  • proportional use of ODEP-rated hip cup and hip stem implants***
  • new consultant indicator

The information is further enhanced through patient-friendly search options and complementary hospital profiles for the same range of data.

Mr Martyn Porter, NJR Medical Director added: “We are delighted to have enhanced the information available to patients this year as well as making surgeons and hospitals easier to find – patients can now search by name, region, GMC code and A-Z list. We will continue to work with surgeons and their hospitals to enhance their data quality and in turn, develop the service for the benefit of future patients.”

Professor Colin Howie, President of the British Orthopaedic Association, commented: “In its second year, we are pleased that these data demonstrate that standards in orthopaedics are high – with very low levels of mortality and no surgeons classed as outliers in terms of their individual performance. I hope patients will be assured about the care they are likely to receive as we move forward in achieving greater transparency for surgical outcomes. Joint replacements such as total hip arthroplasty are one of the most successful and cost-effective procedures in modern medicine.”

The National Joint Registry (NJR), as the appointed national clinical audit, supports the corresponding professional body, the British Orthopaedic Association (BOA), in meeting the requirements of the NHS England initiative.

The NJR is an audit of hip, knee, ankle, elbow and shoulder joint replacement and has been running for more than ten years****. The NJR is currently the largest register of its type in the world with more than 1.75 million operations recorded.

Notes

Press enquiries: For NJR press enquiries, please contact Rebecca Beaumont on 020 7997 7317 or rebecca.beaumont@hqip.org.uk. For BOA press enquiries, please contact Emma Graham on 0207 4056507 and e.graham@boa.ac.uk.

For the BOA visit: www.boa.ac.uk

* A primary operation is the first time a total joint replacement is carried out on any individual joint in a patient. A revision operation, following a primary procedure, removes, replaces or adds to one or more parts of the total joint replacement normally due to loss of function or pain. The number of hip revision operations is the number carried out by the surgeon and these are not necessarily associated with primary procedures undertaken by the surgeon

** Mortality data have been adjusted in an attempt to take into account the varying risk profiles of differing patients (this is called case-mix adjustment and allows surgeon data to be adjusted to show what the mortality would have been had each surgeon operated on the average patient). The aim is to ensure that surgeons who take on complex, higher risk cases are not unfairly criticised for having higher death rates. No orthopaedic surgeons were classed as outliers in terms of individual performance

Mortality information for surgeons is presented as a ‘Funnel plot’, which we feel is the best way to portray this information. Deaths following orthopaedic surgery are a rare event. One surgeon may have a death in his or her first 10 patients while another has 90 patients and only one death – their mortality rates would look very different, but the surgeon with 10 patients may have 80 more cases with no more deaths. It is important that the presentation of this information reflects this. We would emphasise that no surgeons have been found to be outliers in this analysis, and as such all the surgeons’ outcomes are in line with expectations

*** When implants come onto the market they must meet safety guidelines set down by the National Institute for Health and Care Excellence. The level to which implants comply with the guidelines is assessed independently by the Orthopaedic Data Evaluation Panel (ODEP). ODEP assess the quality of follow-up evidence available for each implant – see www.odep.org.uk. There are a number of reasons why an implant may not have an ODEP-rating. For example, new implants that have not been in use for very long or are being used as part of a clinical trial. Or, reflecting that the manufacturer is yet to submit evidence to ODEP for evaluation

**** Data for hip and knee replacement operations have been recorded since 2003. Ankle replacement operations have been recorded since 2011 and elbow and shoulder operations since 2012

Background to consultant outcomes publication
  • December 2012: NHS England (then NHS Commissioning Board) announced that through the 'Everyone Counts' initiative, the activity and outcomes of surgery at individual consultant-level would be published by 30 June 2013 for ten clinical areas
  • July 2013: Orthopaedics was one of the first ten clinical areas to publish consultant-level data for total hip replacements and total knee replacements
  • March 2014: NHS England announced the continuation and extension of consultant-level outcomes publication for the first ten and three new clinical areas
  • The process of publication across all surgical and medical specialties is managed and guided by the Healthcare Quality Improvement Partnership (HQIP) who have set up dedicated pages at their website: www.hqip.org.uk/consultant-outcomes-publication
  
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