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Ein Rapid Review zur Mindestmengenproblematik am Beispiel der Knietotalendoprothese

Woher stammen die magischen Grenzwerte?

A rapid review of associations between provider volume and outcome of total knee arthroplasty

Where do the magical threshold values come from?

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Zusammenfassung

Zur Klärung, ob in Kliniken mit hoher Operationsfrequenz die Mortalität und Morbidität nach Knie-TEP verbessert werden kann, ob die Effekte einheitlich sind und aus den verfügbaren Daten eine in jedem Fall einzuhaltende Mindestmenge abgeleitet werden kann, führten wir eine systematische Literatursuche u. a. in den Datenbanken Medline, Embase, CENTRAL und Cinahlsowie eine manuelle Suche durch—ohne Einschränkung bezüglich des Publikationstyps oder der Sprache. Von 1406 Zitaten verblieben nach einer mehrstufigen Selektionsprozedur 13 Arbeiten mit 1.110.962 Patienten, von denen 6 auf identischen administrativen Datensätzen beruhten. In die Datensynthese flossen 5 Analysen verschiedener Datenquellen mit insgesamt 448.897 Patienten ein. Alle Studien entsprachen dem Evidenzgrad 2b (prospektive und retrospektive Kohortenstudien, konsekutive Stichproben, >80% Follow-up). Die publizierten Daten suggerieren, dass bei jeder 2551. bis 821. Knie-TEP, die in einer Klinik mit hoher Fallzahl anstatt in einer Klinik mit geringerer Fallzahl erfolgt, 1 zusätzlicher Todesfall vermieden wird. Die absoluten Ereignisraten sind jedoch marginal.

Abstract

We set out to clarify whether in hospitals with a large volume morbidity and mortality rates after total knee arthroplasty (TKA) can be improved, whether the effects are consistent, and whether minimum recommendable caseloads can be inferred. We conducted a systematic review using MEDLINE, EMBASE, CENTRAL, and CINAHL and performed a hand search without restrictions on language or publication types. We identified 1406 citations, of which 13 studies including 1,110,962 patients met our inclusion criteria. Of these, six studies explored the same administrative data source. Five studies enrolling 448,897 were eligible for quantitative analysis. All studies corresponded to evidence level 2b (prospective or retrospective cohort study with >80% follow-up). We found homogeneous results about hospital mortality. Between 2551 and 821 TKA must be performed by high-volume rather than by low-volume providers to prevent 1 extra death. Absolute event rates are notably small.

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Danksagung

Die Autoren danken Herrn Dr. Frank Braatz für die kritische Durchsicht des Manuskriptes.

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Authors and Affiliations

  1. Fachbereich Klinische Epidemiologie, Klinik für Unfall- und Wiederherstellungschirurgie des Unfallkrankenhauses Berlin

    D. Stengel & A. Ekkernkamp

  2. Klinik für Unfall- und Wiederherstellungschirurgie des Unfallkrankenhauses Berlin

    D. Stengel & A. Ekkernkamp

  3. Abteilung für Unfall- und Wiederherstellungschirurgie, Klinik und Poliklinik für Chirurgie des Universitätsklinikum Greifswald

    D. Stengel & A. Ekkernkamp

  4. Institut für Klinische Forschung und Dokumentation, Arbeitsgemeinschaft für Osteosynthesefragen (AO CID), Davos, Schweiz

    J. Dettori & B. Hanson

  5. Chirurgische Klinik II—Unfall-, Hand- und Wiederherstellungschirurgie, Evangelisches Diakoniekrankenhaus Schwäbisch Hall

    H. Siebert

  6. Fachbereich Klinische Epidemiologie, Klinik für Unfall- und Wiederherstellungschirurgie des Unfallkrankenhauses Berlin, Warener Straße 7, 12683, Berlin

    D. Stengel

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  1. D. Stengel
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  2. A. Ekkernkamp
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  3. J. Dettori
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  4. B. Hanson
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  5. K. M. Stürmer
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  6. H. Siebert
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Correspondence to D. Stengel.

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Stengel, D., Ekkernkamp, A., Dettori, J. et al. Ein Rapid Review zur Mindestmengenproblematik am Beispiel der Knietotalendoprothese. Unfallchirurg 107, 967–988 (2004). https://doi.org/10.1007/s00113-004-0850-7

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  • DOI: https://doi.org/10.1007/s00113-004-0850-7

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