Trust, Local Health Board and unit-level activity and outcomes

Outlier units for 90-day mortality and revision rates for the period 2003 to 2017

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 surgery. Hospitals with a much higher than expected revision rate for hip and knee replacement have been identified. These hospitals had a revision rate that was above the upper of the 99.8% control limits (these limits approximate to +/-3 standard deviations). We would expect 0.2% (i.e. one in 500) to lie outside the control limits by chance, with approximately half of these (one in 1,000) to be above the upper limit.

When examined over the life of the registry, a total of 29 hospitals reported higher than expected rates of revision for knee replacement and 45 hospitals had higher than expected rates of revision for hip surgery.

However, revisions taken only from the last five years of the registry showed only ten hospitals reporting higher than expected rates for knees, and seven for hips.

The 90-day mortality for hip and knee replacement was calculated using the last five years of data for all hospitals by plotting standardised mortality ratios for each hospital against the expected number of deaths. No hospitals had higher than expected mortality rates for either hip or knee replacement.

Note: The case mix adjustment for mortality includes age, gender and ASA grade. Trauma cases have been excluded from both the hip and knee mortality analyses together with hips implanted for failed hemiarthroplasty or for metastatic cancer (the latter only from November 2014 when recording of this reason began). Also, where both left and right side joints were implanted on the same day, only one side was included in the 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

In earlier annual reports, the NJR reported outlying hospitals based on all cases submitted to the NJR since 1 April 2003. To reflect changes in hospital practices and component use, the NJR now also reports outlying hospitals based on the last five years of data (1 March 2013 to 1 March 2018 inclusive, the latter date being when the dataset was cut). This five year cut of data excludes from the analysis the majority of withdrawn outlier implants, and metal-on-metal total hip replacements, and thus better represents contemporary practice.

Note: 1 Date range 1 April 2003 to 1 March 2018 inclusive.

2 Date range 1 March 2013 to 1 March 2018 inclusive.

Outliers for Hip mortality rates since 2013

None identified

Outliers for Knee mortality rates since 2013

None identified

Outliers for Hip revision rates, all linked primaries from 2003

Ashtead Hospital (Surrey)

Basingstoke and North Hampshire Hospital

BMI Gisburne Park Hospital (Lancashire)

BMI Sarum Road Hospital (Hampshire)

BMI The Somerfield Hospital (Kent)

Cheltenham General Hospital

Clifton Park Hospital (North Yorkshire)

Conquest Hospital

Homerton University Hospital

KIMS Hospital (Kent)

Llandough Hospital

Maidstone District General Hospital

Medway Maritime Hospital

Musgrove Park Hospital

Nevill Hall Hospital

New Hall Hospital (Wiltshire)

North Tyneside General Hospital

Northampton General Hospital (Acute)

Nuffield Health Brighton Hospital (East Sussex)

Nuffield Health Cheltenham Hospital (Gloucestershire)

Nuffield Health Haywards Heath Hospital (West Sussex)

Nuffield Health Tees Hospital (County Durham)

Nuffield Health Wessex Hospital (Hampshire)

Nuffield Health York Hospital (North Yorkshire)

Pilgrim Hospital

Prince Charles Hospital

Rotherham District General Hospital

Royal Cornwall Hospital (Treliske)

Salisbury District Hospital

Shepton Mallet Treatment Centre (Somerset)

Spire Alexandra Hospital (Kent)

Spire Cardiff Hospital (Glamorgan)

Spire Dunedin Hospital (Berkshire)

Spire Tunbridge Wells Hospital (Kent)

St Albans City Hospital

St Michael's Hospital

Sussex Orthopaedic NHS Treatment Centre

The Berkshire Independent Hospital (Berkshire)

The Royal London Hospital

University Hospital (Coventry)

University Hospital of Hartlepool

University Hospital of North Tees

Wansbeck Hospital

Watford General Hospital

York Hospital

 

Outliers for Hip revision rates, all linked primaries from 2013

Homerton University Hospital

KIMS Hospital (Kent)

Salisbury District Hospital

Southampton General Hospital

St Richard's Hospital

Wansbeck Hospital

Weston General Hospital

Outliers for Knee revision rates, all linked primaries from 2003

Bradford Royal Infirmary

BMI Bishops Wood Hospital (Middlesex)

BMI Goring Hall Hospital (West Sussex)

BMI The London Independent Hospital (Greater London)

BMI The Meriden Hospital (West Midlands)

Broadgreen Hospital

Castle Hill Hospital

Charing Cross Hospital

Conquest Hospital

County Hospital Louth

Good Hope Hospital

Guy's Hospital

Hinchingbrooke Hospital

Homerton University Hospital

Horton NHS Treatment Centre (Oxfordshire)

Hospital of St Cross

King Edward VII Hospital Sister Agnes (Greater London)

Kings Mill Hospital

Llandough Hospital

New Hall Hospital (Wiltshire)

Southampton General Hospital

Southmead Hospital

Spire Alexandra Hospital (Kent)

Spire Clare Park Hospital (Surrey)

Spire Southampton Hospital (Hampshire)

St Albans City Hospital

St Richard's Hospital

University College Hospital

Withybush General Hospital

Outliers for Knee revision rates, all linked primaries from 2013

BMI The London Independent Hospital (Greater London)

BMI The Meriden Hospital (West Midlands)

Broadgreen Hospital

Ealing Hospital

Guy's Hospital

Heatherwood Hospital

King Edward VII Hospital Sister Agnes (Greater London)

Leighton Hospital

Nevill Hall Hospital

St Richard's Hospital

Better than expected performance

This year we have again listed hospitals where revision rates are statistically better than expected. The list below shows units that lie below the 99.8% control limit which also achieved greater than 90% compliance in the 2014/15 NJR data quality audit (NHS hospitals only).

Better than expected for Hip revision rates, all linked primaries from 2003

Alexandra Hospital

Bedford Hospital South Wing

Bishop Auckland Hospital

Chapel Allerton Hospital

Harrogate District Hospital

Hereford County Hospital

Ipswich Hospital

Kidderminster Treatment Centre

Manor Hospital

New Cross Hospital

Northern General Hospital

Prince Philip Hospital

Princess Alexandra Hospital

Queen Alexandra Hospital

Queen’s Hospital Burton Upon Trent

Queen’s Medical Centre Nottingham University Hospital

Royal Derby Hospital

Royal Devon & Exeter Hospital (Wonford)

Royal Surrey County Hospital

St Mary's Hospital

Sunderland Royal Hospital

The Great Western Hospital

The Princess Royal Hospital

Wrightington Hospital

Better than expected for Hip revision rates, all linked primaries from 2013

Ipswich Hospital

Royal Devon & Exeter Hospital (Wonford)

Royal Surrey County Hospital

Better than expected for Knee revision rates, all linked primaries from 2003

Bishop Auckland Hospital

Bronglais General Hospital

Darlington Memorial Hospital

Ipswich Hospital

New Cross Hospital

Princess Alexandra Hospital

Queen’s Hospital Burton Upon Trent

Royal Bournemouth Hospital

Royal Derby Hospital

Russells Hall Hospital

Sandwell General Hospital

St Woolos Hospital

Stepping Hill Hospital

Whipps Cross University Hospital

Worcestershire Royal Hospital

Wrightington Hospital

Better than expected for Knee revision rates, all linked primaries from 2013

None identified

 

 

 

 

Unit-level activity and outcomes 2017

Clinical activity

Overall in 2017, 148 NHS Trusts and Local Health Boards (comprising 248 separate hospitals) and 179 independent hospitals were open and eligible to report patient procedures to the NJR. All units except for three trauma units submitted data in 2017. The proportion of all hip and knee joint replacements entered in to 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 and figures would also exclude units in Northern Ireland as compliance data is not available.

• 59% of NHS providers reported 95% or more of the joint replacements they undertook

• 30% of NHS providers reported between 80% and 95%

• 10% of NHS providers reported less than 80%

Of those hospitals submitting data, the proportion of patients who gave permission (consent) for their details to be entered into the NJR were:

 

NHS hospitals

• 46% of NHS hospitals achieved a consent rate of greater than 95%

• 34% achieved a consent rate of 80% to 95%

• 20% recorded a consent rate of less than 80%

Independent hospitals

• 69% of independent hospitals achieved a consent rate greater than 95%

• 24% achieved a consent rate of 80% to 95%

• 7% recorded a consent rate of less than 80%

Similarly, the proportion of entries in which data is available to enable the patient to be linked to an NHS number (linkability) are listed below:

NHS hospitals

• 88% achieved a proportion of patients with a linkable NHS number greater than 95%

• 10% achieved a proportion of 80% to 95%

• 2% recorded a proportion of linkable records of less than 80%

 

Independent hospitals

• 81% achieved a proportion of patients with a linkable NHS number greater than 95%

• 14% achieved a proportion of 80% to 95%

• 5% recorded a proportion of linkable records of less than 80%

Note: 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. Linkability figures are not currently available for Northern Ireland.

Trust, Local Health Board and unit-level activity and outcomes 2017

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 independent (private) providers in England, Wales, Northern Ireland and the Isle of Man for the 2016 calendar year. Outcomes analysis after hip and knee replacement surgery is also provided for the period 2003 to 2017.