At the American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting 2019, I attended a roundtable that discussed how registries are offering more information with the help of Big Data on global orthopaedic care trends.
Experts attending the roundtable included Nathanael D. Heckmann, MD, adult reconstruction fellow in the Department of Orthopaedic Surgery at Rush University Medical Center, and Bryan D. Springer, MD, fellowship director at OrthoCarolina Hip and Knee Center and associate professor of orthopaedic surgery at Carolinas Medical Center.
Both Heckmann and Springer discussed how preliminary findings from the American Joint Replacement Registry (AJRR) compares to more mature national registries.
Heckmann says what drew him to the AJRR registry is how the data can describe trends in much more detail. AJRR collects information from patients aligned with Medicare, and Heckmann says this information in AJRR will be a powerful aspect in shaping and improving patient care moving forward.
Springer says the real importance of a registry, from his perspective, is research. It can indicate early warning signs for implants or techniques. If this information is not being captured in registry data, it could be years before there’s a signal high enough to indicate the implant is not doing its job correctly.
“Currently in the U.S., we capture about thirty percent of hip implants that are going in,” says Springer. “We’re only capturing one-third. Can you imagine capturing 98 percent?”
Now, AJRR is paving the path to encompass more data and information.
“AJRR allowed us to do unique things with the registry,” says Springer. “The acquisition of all Medicare patients that had total joint replacements going back to 2012 has given us continual access to all of that data. The hope is through some other initiatives that are undergoing right now, we’ll be able to get that through all players. We’re really just starting to scratch the surface with what we can do with this national registry.”
Heckmann is optimistic that AJRR can provide new answers to the orthopaedic community moving forward, especially when it pertains to the aging population and amount of broken hips.
“One of the things we found is the tremendous amount of variation in how these patients are treated across the board,” says Springer. “There are best practices on how the femoral component should be fixed into the bone, yet the variation across the spectrum of hospitals is all over the board.”
Both say the registry could stand as an early warning for techniques and could provide predictive information on what works and what doesn’t.
“We want to be able to show that certain types of procedures tie themselves with better outcomes down the line,” Springer says.
Currently, one weakness of the registry, both say, is if the data from the sites is accurate.
“A big educational aspect of things is if they include if the surgery was done with robotic assistance,” says Springer. ”It’s hard to see if it does or does not make a difference. It’s really a matter of how granular we can get people to submit that data.”
As of now, there is not a specific code for submitting a total robotic-assisted surgery.
“There’s no CPT code that lets a researcher know that the procedure was performed with or without,” Springer says.
They hope as AJRR continues to collect data, it gets easier to overcome these challenges and eventually, capture rates can reach a higher percentage allowing for better visualization of trends and success rates.