OUTLIER UNITS FOR 90-DAY MORTALITY OR REVISION RATES FOR THE PERIOD 2003 TO 2013
The observed numbers of revisions of hip and knee replacements for each hospital were compared to the numbers expected given the unit’s case-mix in respect of age, gender and reason for primary. Hospitals with a much higher than expected revision rate for hip and knee replacement have been identified (and can be found listed over the page). These hospitals had a revision rate that was outside the 99.8% (3 standard deviation) limit. In other words, there was a 0.2% (one chance in 500) that this result occurred by chance.
A total of 20 hospitals reported higher than expected rates of revision for knee replacement and 34 hospitals had higher than expected rates of revision for hip surgery.
90-day mortality for hip and knee replacement was calculated for all hospitals by plotting standardised mortality ratios for each hospital against the expected number of deaths. One hospital had a higher than expected mortality rate for knee replacement while none were identified for hip replacement.
Again, when using the 99.8% control limits one hospital in 500 might be expected to be outlying simply by chance, therefore it is possible that this hospital falls in to that category.
Note: Trauma cases have been excluded from hip mortality analysis.
Note: Any units identified as potential outliers in Part Four have been notified. All units are provided with an Annual Clinical Report and additionally, have access to an online NJR Management Feedback system.
Important note about the outlier hospitals listed below
Where an outlier hospital has deviated more markedly than the remainder of the outlier group, this is marked with an asterisk*. This reflects where the revision rate is outside of the upper 99.99% control limits. It is important to note that these results are based on all cases submitted to the NJR since 2003. Some of these outlying hospitals may have changed their practice but their overall results have not yet reflected this change.
Outliers for hip mortality: None identified
Outliers for knee mortality: Redwood Diagnostic Treatment Centre
Outliers for hip revision rates:
Nevill Hall Hospital *
The Royal London Hospital *
Sussex Orthopaedic NHS Treatment Centre *Sussex Orthopaedic NHS Treatment Centre *
Llandough Hospital *
Colchester General Hospital
Prince Charles Hospital *
Queen Elizabeth The Queen Mother Hospital *
Basingstoke and North Hampshire Hospital *
Homerton University Hospital
Medway Maritime Hospital *
University Hospital of Hartlepool *
University Hospital of North Tees *
North Tyneside General Hospital *
St Michael's Hospital
Salisbury District Hospital
Musgrove Park Hospital *
Rotherham District General Hospital *
University Hospital (Coventry)
St Albans City Hospital *
Watford General Hospital *
York Hospital *
BMI The Somerfield Hospital (Kent) *
Nuffield Health Brighton Hospital (East Sussex) *
Nuffield Health Tees Hospital (Cleveland) *
Nuffield Health York Hospital (North Yorkshire) *
Ramsay Ashtead Hospital (Surrey) *
Ramsay Clifton Park Hospital (North Yorkshire) *
Ramsay New Hall Hospital (Wiltshire)
Spire Dunedin Hospital (Berkshire) *
Spire Cardiff Hospital (Glamorgan) *
Spire Gatwick Park Hospital (Surrey)
Spire Tunbridge Wells Hospital (Kent)
Outliers for knee revision rates:
Bradford Royal Infirmary *
Llandough Hospital *
Conquest Hospital *
Withybush General Hospital *
James Paget University Hospital *
Southmead Hospital *
South Tyneside District Hospital
County Hospital Louth
Hospital of St Cross
St Richard's Hospital
St Albans City Hospital *
Care UK Shepton Mallet Treatment Centre (Somerset)
King Edward VII Hospital Sister Agnes (Greater London) *
Ramsay Horton NHS Treatment Centre (Oxfordshire) *
Ramsay New Hall Hospital (Wiltshire) *
Spire Alexandra Hospital (Kent) *
Spire Bushey Hospital (Hertfordshire)
Spire Clare Park Hospital (Surrey)
Spire Southampton Hospital (Hampshire) *
Overall in 2013, 154 NHS Trusts and Local Health Boards (comprising 234 separate hospitals) and 175 independent hospitals reported patients to the NJR. The proportion of joint replacements entered into the NJR against those carried out (compliance) is only available by NHS Trust and Local Health Board. No data on this is currently available from private providers.
- 77% of NHS providers reported 95% or more of the joint replacements they undertook
- 16% of NHS providers reported between 80% and 95% and
- 7% of NHS providers reported less than 80%
Note: these figures exclude units in Northern Ireland as compliance is not available.
The proportion of patients who gave consent for their details to be entered into the NJR (consent) was available for all hospitals:
- 49% of NHS hospitals achieved a consent rate of greater than 95%
- 31% achieved a consent rate of 80% to 95% and
- 20% recorded a consent rate of less than 80%
- 73% of independent hospitals achieved a consent rate greater than 95%
- 17% achieved a consent rate of 80% to 95% and
- 10% recorded a consent rate of less than 80%
Similarly, the proportion of entries in which there is significant data to enable the patient to be linked to an NHS number (linkability) was available for all hospitals:
• 83% achieved a proportion of patients with a linkable NHS number greater than 95%
• 12% achieved a proportion of 80% to 95% and
• 5% recorded a proportion of linkable records of less than 80%
• 51% achieved a proportion of patients with a linkable NHS number greater than 95%
• 39% achieved a proportion of 80% to 95% and
• 10% recorded a proportion of linkable records of less than 80%
Independent hospitals might be expected to have lower linkability rates than NHS hospitals, as a proportion of their patients may come from abroad and not have an NHS number.
Part Four: Trust-, Local Health Board- and unit-level activity and outcomes 2013
Part Four of the annual report gives performance and data entry quality indicators for Trusts, Local Health Boards (many of whom comprise more than one hospital) and private providers in England, Wales and Northern Ireland for the 2013 calendar year. Outcomes analysis after hip and knee replacement surgery is also provided for the period 2003 to 2013.