[Minimal provider volume in total knee replacement : an analysis of the external quality assurance program of North Rhine-Westphalia (QS-NRW)].
BACKGROUND
A minimal provider volume for total knee replacement (TKR) was introduced in 2006. Does this lead to an improvenment in quality or not? The records of treatment in the compulsory external quality assurance program of the Land of North Rhine-Westphalia (QS-NRW) were evaluated.


METHODS
A total of 125,324 comparable records from the QS-NRW program were available to determine the appearance of general and surgical complications. In a logistical regression model the risk factors age, gender, ASA classification, comorbidity and duration were taken into account.


RESULTS
A significant reduction could only be shown for pneumonia, thrombotic events and lung embolisms as well as vascular injury. In 2006 and 2007 malpositioning of implants was significantly higher and from 2005 to 2008 the number of fractures rose compared to 2004. Deep infections and reoperations did not change significantly during the whole study period.


CONCLUSIONS
This evaluation could not show an improvement in quality due to the minimal provider volume. Thus the minimal provider volume should not be taken into account as a main criterion to improve quality. Further outcome studies and creating an arthroplasty register in Germany are more useful.
Kostuj
T
T
Abteilung für Unfallchirurgie, Chirurgische Universitätsklinik, Knappschaftskrankenhaus Bochum - Langendreer Universitätsklinik, Ruhr-Universität, Bochum, Deutschland. tanja.kostuj@kk-bochum.de
Schulze-Raestrup
U
U
Noack
M
M
Buckup
K
K
Smektala
R
R
D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000592:standards*; D002983:Clinical Competence / Q000592:standards*; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011785:Quality Assurance, Health Care / Q000592:standards*; D058996:Quality Improvement / Q000592:standards*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020379:Risk Adjustment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D057772:Vascular System Injuries / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control