Quality Assurance in Primary Total Knee Arthroplasty

Abstract

This study aims to compare internal and external documentation methods, to assess differences in complication rates through time and the potential association of patient parameters with morbidity. Data concerning primary knee arthroplasties performed between 2004 and 2014 were prospectively collected. The Pearson’s chi-squared test or the Fisher’s exact test was used to compare internal with external data and complications documented during 2005-2009 and 2010-2014. The Mann-Whitney U test was used to compare continuous outcomes in the two periods. Furthermore, binary logistic regression analyses were performed with occurrence of surgical complications as dependent variable. The total number of knee arthroplasties was 2100. Postoperative complications were experienced by 212 patients (median age: 72 years) and 30% were male. A significant difference between the internal and external datasets was detected in the “inability to walk at discharge” (p<0.0001) and the “total number of complications” (p=0.02). A significant reduction of the complication rate was observed in the second observation period (p<0.0001). The variables “length of hospital stay” and “duration of operation” independently predicted the occurrence of complications. The observed reduction of complications through time may be attributed to acquired surgical experience and the application of quality assurance measures.