Monitoring surgical performance: an application to total hip replacement.
OBJECTIVE
Inadequate surgical implantation of a hip replacement may result in decreased patient satisfaction and reduced implant survival. The objective was to monitor surgical performance in hip replacement.


METHODS
The study took place at a teaching centre. All primary total hip replacements were prospectively included in the series. For each hip replacement, intraoperative technical errors, cup and stem fixation and position, and postoperative complications were recorded. If all items rated were correct, the procedure was considered as correct. The Cumulative Sums (CUSUM) test was used to monitor the performance of the centre. A 90% proportion of successful procedures was considered as adequate performance and a 75% proportion of successful procedures was deemed as inadequate performance. Meetings were conducted to discuss the results of monitoring.


RESULTS
Eighty-three total hip replacements were monitored. Overall, 28 procedures (34%) were considered inadequate. The most potent reasons for inadequate performance were cup positioning and stem fixation. The CUSUM test signalled after the second procedure that performance was inadequate. After the first meeting, despite an improvement was seen, the CUSUM test raised an alarm indicating inadequate performance. The study was stopped after the second meeting because of funding reasons before it could be demonstrated that performance had reached the desired level.


CONCLUSIONS
This study has demonstrated that implementing a dedicated system to monitor surgical performance in a teaching hospital improves the quality of implantation of total hip replacements. Nonetheless, the target of ninety percent of adequate primary total hip replacement could not be reached and efforts should be continued.
Département de chirurgie orthopédique, Hôpital Cochin, AP-HP, Université Paris 5, France. djmbiau@yahoo.fr
David J
DJ
Biau
Alexandre
A
Milet
Fabrice
F
Thévenin
Philippe
P
Anract
Raphaël
R
Porcher
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000592:standards*; D005602:France / Q000453:epidemiology; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods*