Challenges and barriers to improving care of the musculoskeletal patient of the future - a debate article and global perspective

Patient Safety in Surgery

Javad Parvizi⁵  Michael J Raschke⁸  Karl J Prommersberger²  Christian Krettek¹  Christopher G Moran³  Peter V Giannoudis⁶  R Malcolm Smith⁷  Hans Christoph Pape⁴  Jesse B Jupiter⁷  Hangama C Fayaz⁷ 

[1] Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany;Clinic for Special Hand Surgery, Salzburger Leite 1, 97616 Bad Neustadt an der Saale, Germany;Department of Orthopaedic Trauma, University Hospital, Queen's Medical Centre, GB-Nottingham, NG7 2UH, UK;Department of Orthopaedic Trauma, University of Aachen Medical Center, Pauwelsstraße 30, 52074 Aachen, Germany;Rothman Institute of Orthopedics Philadelphia, Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA;Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds LS2 9JT, UK;Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA;Department of Trauma Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany

关键词: Registries;    Quality assurance in Patient care;    Algorithms of patient care;    Future trends and needs;    Global perspective;   

Others  :  790383
DOI  :  10.1186/1754-9493-5-23

 received in 2011-08-16, accepted in 2011-09-25,  发布年份 2011

【 摘 要 】

Background

With greater technological developments in the care of musculoskeletal patients, we are entering an era of rapid change in our understanding of the pathophysiology of traumatic injury; assessment and treatment of polytrauma and related disorders; and treatment outcomes. In developed countries, it is very likely that we will have algorithms for the approach to many musculoskeletal disorders as we strive for the best approach with which to evaluate treatment success. This debate article is founded on predictions of future health care needs that are solely based on the subjective inputs and opinions of the world's leading orthopedic surgeons.

Hence, it functions more as a forum-based rather than a scientific-based presentation. This exposé was designed to stimulate debate about the emerging patients' needs in the future predicted by leading orthopedic surgeons that provide some hint as to the right direction for orthopedic care and outlines the important topics in this area.

Discussion

The authors aim to provide a general overview of orthopedic care in a typical developed country setting. However, the regional diversity of the United States and every other industrialized nation should be considered as a cofactor that may vary to some extent from our vision of improved orthopedic and trauma care of the musculoskeletal patient on an interregional level.

In this forum, we will define the current and future barriers in developed countries related to musculoskeletal trauma, total joint arthroplasty, patient safety and injuries related to military conflicts, all problems that will only increase as populations age, become more mobile, and deal with political crisis.

Summary

It is very likely that the future will bring a more biological approach to fracture care with less invasive surgical procedures, flexible implants, and more rapid rehabilitation methods. This international consortium challenges the trauma and implants community to develop outcome registries that are managed through health care offices and to prepare effectively for the many future challenges that lie in store for those who treat musculoskeletal conditions.

【 授权许可】

   
2011 Fayaz et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]US Census Bureau: US interim projections by age, sex, race, and Hispanic origin: 2000-2050. [http://census.gov/population/www/projections/usinterimproj/] webcite Accessed 2009 June 24
• [2]Loh S, George MV: Projected population size and age structure for Canada and provinces: with and without international migration. Can Stud Popul 2007, 34(2):103-127.
• [3]Bhandari M, Schemitsch EH: Stimulation of fracture healing: Osteobiologics, Bone Stimulators, and Beyond. J Orthop Trauma 2010, 24(Suppl 3):S1.
• [4]Rozental TD, Makhni EC, Day CS, Bouxsein ML: Improving evaluation and treatment for osteoporosis following distal radial fractures. A prospective randomized intervention. J Bone Joint Surg Am 2008, 90(5):953-961.
• [5]Starr AJ, Smith WR, Frawley WH, Borer DS, Morgan SJ, Reinert CM, Mendoza-Welch M: Symptoms of posttraumatic stress disorder after orthopaedic trauma. J Bone Joint Surg Am 2004, 86-A(6):1115-1121.
• [6]Cuomo AV, Lieberman JR: The Future of Musculoskeletal Tissue Regeneration: A Clinical Perspective. In Musculoskeletal Tissue Regeneration. Edited by Pietrzak WS. Humana Press; 2008:619-634.
• [7]Hofmann A, Ritz U, Hessmann MH, Schmid C, Tresch A, Rompe JD, Meurer A, Rommens PM: Cell viability, osteoblast differentiation, gene expression are altered in human osteoblasts from hypertrophic fracture non-unions. Bone 2008, 42(5):894-906.
• [8]Benson K, Hartz AJ: A comparison of observational studies and randomized, controlled trials. N Engl J Med 2000, 342(25):1878-1886.
• [9]Concato J, Shah N, Horwitz RI: Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med 2000, 342(25):1887-1892.
• [10]Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Jarvinen M: Nationwide decline in incidence of hip fracture. J Bone Miner Res 2006, 21(12):1836-1838.
• [11]Sehgal A, Vadhavkar S, Mithal A, Singh GSI: A victory in the war on osteoporosis? Declining prevalence of hospitalizations for non-traumatic hip fractures in the US. Ann Rheum Dis 2008, 67(Suppl II):55.
• [12]Quintana JM, Arostegui I, Escobar A, Azkarate J, Goenaga JI, Lafuente I: Prevalence of knee and hip osteoarthritis and the appropriateness of joint replacement in an older population. Arch Intern Med 2008, 168(14):1576-1584.
• [13]Grotle M, Hagen KB, Natvig B, Dahl FA, Kvien TK: Prevalence and burden of osteoarthritis: results from a population survey in Norway. J Rheumatol 2008, 35(4):677-684.
• [14]Andrianakos AA, Kontelis LK, Karamitsos DG, Aslanidis SI, Georgountzos AI, Kaziolas GO, Pantelidou KV, Vafiadou EV, Dantis PC, ESORDIG Study Group: Prevalence of symptomatic knee, hand, and hip osteoarthritis in Greece. The ESORDIG study. J Rheumatol 2006, 33(12):2507-2513.
• [15]Bourne R, Mukhi S, Zhu N, Keresteci M, Marin M: Role of obesity on the risk for total hip or knee arthroplasty. Clin Orthop Relat Res 2007, 465:185-188.
• [16]Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J: Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty 2008, 23(7):984-991.
• [17]Dunbar MJ, Howard A, Bogoch ER, Parvizi J, Kreder HJ: Orthopaedics in 2020: Predictors of Musculoskeltal Need. J Bone and Joint Surg Am 2009, 91(9):2276-2286.
• [18]Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M: Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 2005, 87(7):1487-1497.
• [19]The Swedish National Hip Arthroplasty Register [https://www.jru.orthop.gu.se/] webciteAnnual report 2004 2005.
• [20]Kurtz S, Ong k, Lau E, Mowat F, Halpern M: Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007, 89(4):780-785.
• [21]Malchau H, Herberts P, Eisler T, Garellick G, Soderman P: The Swedish Total Hip Replacement Register. J Bone Joint Surg Am 2002, 84(Suppl 2):2-20.
• [22]Julin J, Jaemsen E, Puolakka T, Konttinen YT, Moilanen T: Younger age increases the risk of early prosthesis failure following primary total knee replacement for osteoarthritis. A follow-up study of 32,019 total knee replacements in the Finnish Arthroplasty Register. Acta Orthopaedica 2010, 81(4):413-419.
• [23]Iorio R, Healy WL, Applegate T: Validity of preoperative demand matching as an indicator of activity after TKA. Clin Orthop 2006, (452):44-48.
• [24]Amin AK, Clayton RAE, Patton JT, Gaston M, Cook RE, Brenkel IJ: Total knee replacement in morbidly obese patients: Results of a prospective matched study. J Bone Joint Surg Br 2006, 88(10):1321-1326.
• [25]Changulani M, Kalairajah Y, Peel T, Field RE: The relationship between obesity and the age at which hip and knee replacement is undertaken. J Bone Joint Surg Br 2008, 90(3):360-363.
• [26]Higgins GA, Davis ET, Revell M, Porter K: The management and treatment of peri-prosthetic fractures around both total hip and hemiarthroplasty. Trauma 2009, 11:49-61.
• [27]Sarvilinna R, Huhtala HS, Sovelius RT, Halonen PJ, Nevalainen JK, Pajamaki KJ: Factors predisposing to periprosthetic fracture after hip arthroplasty: a case (n = 31)-control study. Acta Orthopaedica Scandinavica 2004, 75(1):16-20.
• [28]Berry DJ: Epidemiology: hip and knee. Orthop Clin North Am 1999, 30(2):183-190.
• [29]Berry DJ: Periprosthetic fractures associated with osteolysis: a problem on the rise. J Arthroplasty 2003, 18(3 Suppl 1):107--111.
• [30]Stahel PF, Sabel AL, Victoroff MS, Varnell J, Lembitz A, Boyle DJ, Clarke TJ, Smith WR, Mehler PS: Wrong-site and wrong-patient procedures in the universal protocol era: analysis of a prospective database of physician self-reported occurrences. Arch Surg 2010, 145(10):978-984.
• [31]Ring DC, Herndon JH, Meyer GS: A 65-year-old woman with an incorrect operation on the left hand. N Engl J Med 2010, 363(20):1950-1957.
• [32]Wong DA, Herndon JH, Canale ST, Brooks RL, Hunt TR, Epps HR, Fountain SS, Albanese SA, Johanson NA: Medical errors in orthopaedics: results of an AAOS member survey. J Bone Joint Surg Am 2009, 91(3):547-557.
• [33]Stahel PF, Mehler PS, Clarke TJ, Varnell J: The 5th anniversary of the "Universal Protocol": pitfalls and pearls revisited. Patient Safety in Surg 2009, 3(1):14. BioMed Central Full Text
• [34]Landrigan CP, Parry GJ, Bones CB, Hackbarth AD, Goldmann DA, Sharek PJ: Temporal trends in rates of patient harm resulting from medical care. N Engl J Med 2010, 363(22):2124-2134.
• [35]de Vries EN, Prins HA, Crolla RM, den Outer AJ, van Andel G, van Helden SH, Schlack WS, van Putten MA, Gouma DJ, Dijkgraaf MG, Smorenburg SM, Boermeester MA: SURPASS Collaborative Group. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med 2010, 363(20):1928-1937.
• [36]Neily J, Mills PD, Young-Xu Y, Carney BT, West P, Berger DH, Mazzia LM, Paull DE, Bagian JP: Association between implementation of a medical team training program and surgical mortality. JAMA 2010, 304(15):1693-1700.
• [37]Stahel PF, Flierl MA, Smith WR, Morgan SJ, Victoroff MS, Clarke TJ, Sabel AL, Mehler PS: Disclosure and reporting of surgical complications: a double-edged sword? Am J Med Qual 2010, 25(5):398-401.
• [38]Stahel PF, Clavien PA, Hahnloser D, Smith WR: A new journal devoted to patient safety in surgery: the time is now! Patient Safety in Surg 2007, 1(1):1. BioMed Central Full Text
• [39]Gallagher TH, Studdert D, Levinson W: Disclosing harmful medical errors to patients. N Engl J Med 2007, 356(26):2713-2719.
• [40]Murphy JG, Stee L, McEvoy MT, Oshiro J: Journal reporting of medical errors: the wisdom of Solomon, the bravery of Achilles, and the foolishness of Pan. Chest 2007, 131(3):890-896.