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Indicator Metadata

NameKnee Replacement Rate
Short/Other Names

Age-Standardized Rate for Knee Replacements

Description

This indicator measures the age-standardized rate of all knee replacement procedures performed in acute care hospitals or same-day surgery facilities per 100,000 population age 18 and older.

Analysis reflects all knee replacement types: total knee replacement, unicompartmental knee replacement (medial, lateral or patellofemoral) and patella-only procedures.

For further details, please see the General Methodology Notes.

InterpretationDoes not apply to this measure (that is, there is no predefined preference for the measure score)
HSP Framework Dimension

Health System Inputs and Characteristics: Health system resources

Areas of Need

Not applicable

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Region

Indicator Results

http://www.cihi.ca/hirpt/?language=en

Identifying Information
NameKnee Replacement Rate
Short/Other Names

Age-Standardized Rate for Knee Replacements

Indicator Description and Calculation
Description

This indicator measures the age-standardized rate of all knee replacement procedures performed in acute care hospitals or same-day surgery facilities per 100,000 population age 18 and older.

Analysis reflects all knee replacement types: total knee replacement, unicompartmental knee replacement (medial, lateral or patellofemoral) and patella-only procedures.

For further details, please see the General Methodology Notes.

Calculation: Description(Total number of discharges for all knee replacements for persons age 18 and older ÷ Total mid-year population age 18 and older) × 100,000 (age-adjusted)
Calculation: Geographic Assignment

Place of residence

Calculation: Type of Measurement

Rate - Per 100,000

Calculation: Adjustment Applied

Age-adjusted

Calculation: Method of Adjustment

Direct Standardization
Standard Population:
Canada 2011

Denominator

Description:
Total mid-year population age 18 and older

Numerator

Description:
Total number of discharges for all knee replacement procedures for persons age 18 and older

Unit of analysis: Single admission

Inclusions:
1. Knee replacement procedures

CCI: 1.VG.53^^ and 1.VP.53^^

Note: Rates are based on the total number of discharges for knee replacement procedures in a given year. Therefore, a patient who received a simultaneous bilateral knee replacement or underwent multiple knee replacement procedures within a single hospital admission would be counted only once.

2. Age at admission: 18 and older

3. Sex recorded as male or female

4. Admission to an acute care institution or day surgery facility (Facility Type Code = 1 or A)
Exclusions:
1. Records with cement spacers not coded as revision (intervention code 1VG53LASLN and Intervention Status Attribute does not equal R)

2. Knee replacement procedures that were abandoned after onset or performed out of hospital (Intervention Status Attribute = A or OOH Indicator Flag = Y)

3. Newborn, stillbirth or cadaveric donor records (Admission Category Code = N, R or S)

Background, Interpretation and Benchmarks
Rationale

Knee replacement surgery has the potential to improve functional status, reduce pain and contribute to other gains in health-related quality of life. Over the past two decades, rates of knee replacement procedures have increased substantially. Wide inter-regional variation in joint replacement rates may be attributable to numerous factors, including the availability of services, provider practice patterns and patient preferences.

Interpretation

Does not apply to this measure (that is, there is no predefined preference for the measure score)

HSP Framework Dimension

Health System Inputs and Characteristics: Health system resources

Areas of Need

Not applicable

Targets/Benchmarks

Not applicable

References

Not applicable

Availability of Data Sources and Results
Data Sources

HMDB, NACRS

Available Data Years

Type of Year:
Fiscal
First Available Year:
2008
Last Available Year:
2015

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Region

Result Updates
Update Frequency

Every year

Indicator Results

Web Tool:
Health Indicators E-Publication
URL: http://www.cihi.ca/hirpt/?language=en

Updates

Not applicable

Quality Statement
Caveats and Limitations

Rates are based on the total number of discharges for knee replacement procedures in a given year. However, it is possible for a patient to undergo more than 1 knee replacement procedure in a single discharge.

Trending Issues

Prior to 2013–2014, the Canadian Joint Replacement Registry (CJRR) annual report (https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC2625&lang=en&media=0) included results for knee replacements performed in acute care hospitals only. Beginning in 2013-2014, the results for knee replacement include both acute and day surgery cases.

As of 2013–2014, the knee replacement rates published in the Health Indicators E-Publication include additional patella-only replacement procedures. Comparability with previous years might be affected.

Comments

1. Regional results are available in the Health Indicators E-Publication.

2. Provincial results are also available in the CJRR annual report (https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC2625&lang=en&media=0). Please note the following:

–Prior to 2013–2014, results for Yukon, the Northwest Territories and Nunavut were suppressed in the CJRR annual report (https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC2625&lang=en&media=0). However, their numbers are included in Canadian calculations.

–As of 2013–2014, knee replacements from day surgery settings are included in the CJRR annual report (https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC2625&lang=en&media=0).

–Calculation of a patient's geography in the Health Indicators E-Publication is based on the Postal Code Conversion File (PCCF), whereas in the CJRR annual report (https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC2625&lang=en&media=0) it is based on the forward sortation area (FSA).

–Beginning with 2015–2016 data, procedures involving implantation of a cement spacer are excluded from knee replacement cases when it is not part of a revision surgery; comparability with previous years should not be affected.