Auditorías clínicas del procedimiento de la artroplastia total de cadera y su impacto en la mejora de la calidad asistencial

Abstract

Background Clinical audits are critical and systematic quality analysis of medical care. Total hip arthroplasty (THA) is a routine practice and cost-effective, although there is little information on the quality of care of it. Objective To evaluate the impact of a clinical audit cycle in the quality of care in the primary THA procedures for non-traumatic cause. Patients and methods A series of two audits (first audit in 2005 and second one in 2007) were performed. Patients of both sexes with non-traumatic primary THA and with a follow-up of 6 months were included. Time (days) in hospital stay and the rate (percentage) of readmissions were used as indicators of management; and as indicators of clinical practice: the index (percentage) of dislocation and the rate (percentage) of infection. Both audits were compared with respect to these indicators. Results A total of 160 patients (79 and 81, first and second audit respectively) were analysed. Management indicators: median (range) of hospital stay was 8 (7-78) and 7 (6-16), p < 0.001, and the percentage of readmissions 5% (4/79) and 0 (0/81), p = 0.057. Indicators of clinical practice: the rate of dislocation was 8% (6/79) and 0 (0/81), p = 0.013, and the rate of infection 1% (1/79) and 1% (1/81), p = 1. A multivariate analysis did not find other factors related to these indicators. Conclusions The implementation of a clinical audit cycle has improved the quality of care of primary THA procedures for non-traumatic cause.