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Comparing the quality of care across Belgian hospitals from medical basic datasets: the case of thromboembolism prophylaxis after major orthopaedic surgery
Author(s) -
Gerkens Sophie,
Crott Ralph,
Closon MarieChristine,
Horsmans Yves,
Beguin Claire
Publication year - 2010
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/j.1365-2753.2009.01175.x
Subject(s) - medicine , fondaparinux , pulmonary embolism , context (archaeology) , confidence interval , incidence (geometry) , orthopedic surgery , knee replacement , venous thromboembolism , emergency medicine , adverse effect , surgery , thrombosis , paleontology , physics , optics , biology
Rationale, aims and objectives In the current context, the assessment of the quality of care in daily clinical practice becomes essential. The aim of this study was to use medical basic datasets associated with information on pharmacological treatments to assess the quality of care of a prophylaxis treatment after major orthopaedic surgery and to compare hospitals' clinical practices. Methods The study was performed in 20 Belgian hospitals. Patients who underwent total hip replacement (THR), total knee replacement (TKR), or hip fracture surgery (HFS) were selected retrospectively from the hospitals' 2002 and 2003 administrative databases ( n = 14 991). Quality indicators assessed were incidence of venous thromboembolism, major bleeding and death. Prophylaxis analysed were enoxaparin, nadroparin and fondaparinux. Results Venous thromboembolism and major bleeding events were rare (1.9% and 1.1% respectively). Patients who underwent HFS were at greater risk of having pulmonary embolism [OR = 2.01; confidence interval (CI) = 1.38–2.92; P = 0.0002], major bleeding (OR = 4.00; CI = 2.93–5.46; P < 0.0001) or death from any cause (OR = 8.86; CI = 6.85–11.45; P < 0.0001) than patients who underwent THR or TKR. Multivariate analyses showed that the hospital variable had a significant impact on the probability to have adverse events and that patients who received enoxaparin were at greater risk of death than patients who received nadroparin (OR enoxaparin vs fraxiparin = 1.59; 95% CI = 1.04–2.44; P = 0.033). Conclusion Results indicate that differences in thromboembolism prophylaxis practices among hospitals have a significant impact on adverse events. This reinforces the need to develop data‐processing tools that enable better monitoring of quality of care.