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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Demonstrating the Value of an ACL Registry
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Demonstrating the Value of an ACL Registry

机译：展示ACL注册中心的价值

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Objectives: One purpose of a registry is to identify procedures or devices that have either good or poor outcomes and improve treatment outcomes through feedback to surgeons. In 2010 we initially reported the influence of graft choice on the risk of early revision after ACL Reconstruction (ACLR). In 2012 we reported a three times higher risk of revision if allograft was used rather than bone-patellar tendon-bone (BPTB) autograft. In subsequent studies of allografts, we have identified poorer results with BPTB allografts compared to soft tissue allografts and with soft tissue allografts irradiated with > 1.8 Mrads or processed with chemical methods. Patients < 21 years of age were also identified to be at particularly high-risk for revision if allograft tissue was employed. These registry findings were disseminated to surgeons within and outside our integrated healthcare system. The purpose of this study was to evaluate the impact of registry feedback on surgeon graft type selection. Methods: Feedback to surgeons on graft performance was presented through a variety of mechanisms including (1) peer-reviewed publications, (2) internal and external meetings and conferences (3) newsletters of study findings, (4) Risk calculators and (5) confidential individualized reports of surgeon’s outcomes. In addition, surgeon champions set a quality improvement goal to reduce allograft usage overall and specifically to decrease the use of high risk grafts and usage in high-risk patient groups. Allograft usage was monitored on a quarterly basis to determine if the target was achieved. Annual graft utilization from 2008-2015 is reported here as proportions, for the overall cohort and for high-risk subgroups. Results: Our integrated healthcare system’s ACLR registry currently includes over 35,000 patients. Beginning in 2008, the annual proportion of ACLR cases using an allograft increased with a peak of 45% in 2010. Allograft use has decreased in the ensuing years and was 33% in 2015, a decrease of 27%. High-risk graft usage decreased from 8% in 2011 to 5% in 2015 which is a 38% decrease. Allograft use in patients < 21 years of age decreased 68% from a high of 28% in 2009 to 9% in 2015. (see Figure) Conclusion: Translating registry findings into evidence-based clinical practice is the goal of a registry. In this study, we found that information derived from an ACL Registry and disseminated to the participants can directly influence the use of specific procedures or implants that are associated with poor outcomes. Registries can provide useful information that may ultimately be used to improve patient care.
机译：目标：注册表的一个目的是确定结果好坏的程序或设备，并通过反馈给外科医生来改善治疗效果。在2010年，我们最初报道了移植物选择对ACL重建（ACLR）后早期翻修风险的影响。在2012年，我们报道如果使用同种异体移植而不是bone骨肌腱-骨（BPTB）自体移植，则翻修风险高三倍。在随后的同种异体移植研究中，我们发现与软组织同种异体移植物和用> 1.8 Mrads辐照或用化学方法处理的同种异体软组织移植物相比，BPTB同种异体移植物的结果较差。如果采用同种异体移植组织，<21岁的患者也被确定特别容易发生翻修。这些注册表结果已分发给我们集成医疗系统内外的外科医生。这项研究的目的是评估注册表反馈对外科医生移植物类型选择的影响。方法：通过多种机制向外科医生提供了有关移植物性能的反馈，包括（1）经过同行评审的出版物，（2）内部和外部会议（3）研究结果通讯，（4）风险计算器和（5）保密的个性化外科医生结果报告。此外，外科医生倡导者设定了质量改进目标，以总体上减少同种异体移植物的使用，特别是减少高风险移植物的使用和高风险患者组的使用。每季度监测同种异体移植的使用情况，以确定是否达到目标。此处报告了整个队列和高风险亚组从2008-2015年的每年移植物利用率。结果：我们的综合医疗保健系统的ACLR注册中心目前包括35,000多名患者。从2008年开始，使用同种异体移植的ACLR病例的年比例增加，2010年达到峰值，为45％。随后几年，同种异体移植的使用有所减少，2015年为33％，减少了27％。高风险移植物使用率从2011年的8％下降到2015年的5％，下降了38％。 <21岁以下患者的同种异体移植使用率从2009年的最高28％下降到2015年的9％，降低了68％。（见图）结论：注册管理机构的目标是将注册管理机构的发现转化为循证临床实践。在这项研究中，我们发现从ACL注册中心获得并传播给参与者的信息可以直接影响与不良结果相关的特定程序或植入物的使用。注册表可以提供有用的信息，这些信息最终可用于改善患者护理。

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