Improving Orthopedic Outcomes Through a National TJR Registry

描述(申请人提供)：每年有超过700,000名美国成年人选择全关节置换(TJR)手术，以恢复身体功能，消除晚期膝关节炎或髋关节炎的疼痛，尽管接受了全面的医疗治疗。尽管被广泛使用，但在手术实践和结果上仍然存在很大的差异。此外，缺乏比较有效的数据来指导外科医生和患者在最佳植入时机、手术入路、植入物选择和围手术期处理方面的决策，以防止不良后遗症和翻修。因此，国家整形外科结果登记(NOOR)和队列研究将建立一个全国性登记，包括来自全国所有地区和不同医院和外科医生执业环境的130名整形外科医生的33,000多名不同患者。因此，注册是为了反映典型的美国临床实践，而不是只关注大容量的学术中心。数据将包括基线患者属性；手术方法和技术；医院进程；外科医生和机构特征；纵向患者功能、手术后并发症和修订，以及血清/DNA样本。基于网络的数据收集将提高数据收集的效率。研究小组将开发新的结果衡量标准，并将确定患者因素、技术使用和交付因素对(1)早期功能衰竭和(2)关节置换后不良事件的相对贡献；(3)检查TJR使用和结果的差异，试图阐明根本原因；(4)进行经济分析，以确定TJR在工作老年人中的个人和社会价值。全国骨科医生网络将与在大规模登记册开发和实施、基于网络的技术、成果衡量和统计技术方面具有专长的创新科学家合作，以确保成功。健全的治理原则将确保有效执行。登记册将积极鼓励辅助研究，以确保最佳利用所有数据和生物材料。我们建议将临床中心和整形外科办公室的网络转变为研究实验室，作为比较有效性研究的全国样板。 公共卫生相关性：拟议的国家整形外科结果登记将收集重要的患者、手术和分娩设置数据，以回答关键患者和外科医生的问题，这些问题涉及最佳植入物选择、手术时机和入路，以及每年接受全关节置换和其他手术的大量患者的围术期护理。研究还将解决年轻患者的TJR值和使用差异，

DESCRIPTION (provided by applicant): Each year, more than 700,000 US adults elect total joint replacement (TJR) surgery to restore physical function and eliminate the pain of advanced knee or hip arthritis that persists despite comprehensive medical treatment. Despite broad use, wide variation persists in surgical practice and outcomes. Furthermore, there is a lack of comparative effectiveness data to guide surgeon and patient decisions on optimal implant timing, surgical approach, implant selection, and peri-operative management to prevent adverse sequelae and revision. Therefore, the National Orthopedic Outcome Registry (NOOR) and Cohort Study will establish a national registry of over 33,000 diverse patients of 130 orthopedic surgeons representing all regions of the country and varied hospital and surgeon practice settings. As such, the registry is designed to reflect typical US clinical practice, rather than focusing exclusively on high-volume academic centers. Data will include baseline patient attributes; procedure approach and technology; hospital course; surgeon and institutional characteristics; longitudinal patient function, post-procedure complications and revisions, and serum/DNA samples. Web-based data collection will enhance efficient data gathering. The research team will develop new outcome measures and will determine the relative contributions of patient factors, technology use, and delivery factors to (1) early functional failure and (2) adverse post-arthroplasty events; (3) examine disparities in TJR use and outcome, seeking to elucidate root causes; and (4) conduct economic analyses to determine the personal and societal value of TJR in working aged adults. A national network of orthopedists will partner with innovative scientists with expertise in large-scale registry development and implementation, web-based technology, outcome measurement, and statistical techniques to assure success. Sound governance principles will ensure efficient implementation. The registry will actively encourage ancillary research to assure optimal use of all data and biomaterials. We propose to transform the network of clinical centers and orthopedic offices into a research laboratory that will serve as a national model for comparative effectiveness research. PUBLIC HEALTH RELEVANCE: The proposed national orthopedic outcome registry will collect important patient, surgical, and delivery setting data to answer critical patient and surgeon questions about optimal implant selection, surgical timing and approach, and peri-operative care for the large number of patients who undergo total joint replacement and other procedures each year. Research will also address TJR value in young patients and use disparities,