There are currently three types of organisation in England, Wales, and Northern Ireland undertaking hip, knee, ankle, shoulder, and elbow joint replacement surgery. The Isle of Man) joins the NJR from July 2015.
There are no ISTCs in either Wales or Northern Ireland (or the Isle of Man).
Table: Proportion of reported procedures by type of provider, 2010/11 to 2014/15
As at 31 March 2015, 1,879,229 hip, knee, ankle, shoulder, and elbow joint procedures had been submitted to the NJR. There were 226,871 procedure submissions in 2014/15, the highest annual rate of submissions and re-submissions for any year since the NJR started to collect data in 2003.
The table below shows, by country and joint type, the number of procedures reported to the NJR for the financial years from 2010/11 to 2014/15. As for the previous five years, the number of knee replacement procedures (111,606) exceeded the number of hip replacement procedures (107,328) in 2014/15 (51.0% and 49.0% as a proportion).
Table: Total joint replacement procedures entered into the NJR, 2010/11 to 2014/15, recorded by country in which the procedure took place
Operation types The table below shows the number of procedures reported by type from 1 April 2010 to 31 March 2015. Primary procedures make up 91.9% of all procedures reported during 2014/15, whilst the proportion of revisions has decreased to 8.1%, from 8.6% in 2013/14.Table: Total joint replacement procedures entered into the NJR 2010/11 to 2014/15, recorded by procedure type
The table below shows the number of procedures reported by type from 1 April 2010 to 31 March 2015. Primary procedures make up 91.9% of all procedures reported during 2014/15, whilst the proportion of revisions has decreased to 8.1%, from 8.6% in 2013/14.Table: Total joint replacement procedures entered into the NJR 2010/11 to 2014/15, recorded by procedure type
The table below shows the number of procedures reported by type from 1 April 2010 to 31 March 2015. Primary procedures make up 91.9% of all procedures reported during 2014/15, whilst the proportion of revisions has decreased to 8.1%, from 8.6% in 2013/14.
The linkability rate for 2014/15 was 92.8%, a decrease from 2013/14
The linkability rate compares the number of records submitted with the patient’s NHS number with the number of procedures recorded in the NJR. The NHS number is required to link all primary and revision procedures relating to a single patient (NJR data is submitted for NHS number tracing and validation and the linkability rate includes NHS numbers that have been traced subsequent to the operation details being submitted to the NJR.
The ability to link all operations relating to a single patient is vital in determining clinical outcomes and, without a high NHS number submission rate, the NJR’s ability to monitor clinical and implant performance is adversely affected.
Where the NHS number is missing, tracing is attempted using the NHS Demographics Batch Service. This does, however, require the patient’s name, date of birth and postcode being correctly submitted.
The decrease in linkability is due to two factors:
Currently, there is no way of tracing records in Northern Ireland where no Health Care Number (HCN) has been submitted. As a result, these records cannot currently be linked to other procedures for the same patient. However, work is in progress with the Department of Health, Social Services, and Public Safety Northern Ireland (DHSSPS) to establish such a process.
Secondly, the addition of ‘correct patient details’ functionality two years ago moves non-linkable procedures to the current year. If a record from 2008/09, for example, is edited by a hospital the ‘completion date’ of the record would change to the current year, even if the trace had been unsuccessful. These records will continue a cycle of tracing and editing until they are complete which means the number of the reported procedures for the current reporting year will continue to increase year on year at the same time as the linkability for older years will increase. A comparison of the linkability figures published last year with the table above demonstrates this effect. For example, last year’s report showed linkability for 2007/08 as being 84.4%: this year linkability for 2007/08 is being reported as 91.8%. It is expected that the lower linkage rate reported this year will start to improve from next year.
The consent rate for 2014/15 was 93.8%, a slight increase from 2013/14
The consent rate compares the number of records submitted where the patient has agreed to their personal data (see note below) being stored on the NJR database with the number of procedures recorded on the NJR. It is a requirement in England, Wales and Northern Ireland that patients give voluntary consent to have their personal data held on the NJR with their operation data. This personal information is essential to link patients’ primary and revision procedures together in order to monitor the outcomes of joint replacement surgery. Without high rates of consent, the NJR cannot achieve its goals.
Patients rarely decline consent and many units achieve consent rates of 100%. Lower consent rates in other units are generally caused by a lack of robust processes which mean that the completed consent form is not available to the person submitting the procedure details to the NJR.
The compliance rate from 1 April 2014 to 31 March 2015 for hip and knee submissions was 96.0% for NHS hospitals in England and Wales
Prior to 1 April 2014, the compliance rate was measured by comparing the number of levies paid against the number of procedures submitted to the NJR. With the adoption of a subscription model in April 2014, it is no longer possible to measure the compliance rate in this way.
Compliance for hip and knee procedures is compared to submissions made to the Hospital Episodes Statistics (HES) service in England and to the Patient Episode Database Wales (PEDW) service in Wales.
Whilst the use of HES and PEDW data enables the measurement of the rate of compliance for Trusts and Health Boards, it does not include those procedures undertaken in the independent sector. The NJR is currently exploring the establishment of a data sharing agreement with the Private Healthcare Information Network (PHIN) which would enable the NJR to use Private HES (PHES) data from the independent sector to monitor compliance.
About the key indicators of data quality and completeness
It is mandatory for the following providers of joint replacement surgery to collect and submit data to the NJR:
Performance against the three key indicators of data quality (compliance, consent, and linkability) has been variable over the last year and the monitoring of, and support to, orthopaedic units has been maintained at a high level. Unit-level performance against these key indicators is provided in Part Four of the report, available as a PDF download from the right-hand side of the page.
This data is also provided through the NJR StatsOnline service, and in a standard annual clinical report provided to Trust and Health Board chief executives and independent healthcare companies.
With the move from a levy to a subscription model and the difficulties encountered in obtaining data from the NHS Health and Social Care Information Centre (NHS HSCIC), it is not possible to provide an overall figure for compliance for the financial year 1 April 2014 to 31 March 2015. This is explained more fully under the ‘Compliance’ section.
Highlights: Our work
NJR Surgeon and Hospital Profile
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NJR 12th Annual Report 2015
Online appendices - NJR 12th Annual Report 2015
Prostheses used in hip, knee, ankle, elbow and shoulder replacement procedures
Trust-, Local Health Board- and unit-level activity and outcomes
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