ORCID Profile
0000-0003-3388-1476
Current Organisation
Flinders University
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Publisher: SAGE Publications
Date: 28-09-2023
Publisher: Elsevier BV
Date: 04-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-07-2021
DOI: 10.1097/CORR.0000000000001895
Abstract: When analyzing the outcomes of joint arthroplasty, an important factor to consider is patient comorbidities. The presence of multiple comorbidities has been associated with longer hospital stays, more postoperative complications, and increased mortality. The American Society of Anesthesiologists (ASA) physical status classification system score is a measure of a patient’s overall health and has been shown to be associated with complications and mortality after joint arthroplasty. The Rx-Risk score is another measure for determining the number of different health conditions for which an in idual is treated, with a possible score ranging from 0 to 47. For patients undergoing THA or TKA, we asked: (1) Which metric, the Rx-Risk score or the ASA score, correlates more closely with 30- and 90-day mortality after TKA or THA? (2) Is the Rx-Risk score correlated with the ASA score? This was a retrospective analysis of the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) database linked to two other national databases, the National Death Index (NDI) database and the Pharmaceutical Benefits Scheme (PBS), a dispensing database. Linkage to the NDI provided outcome information on patient death, including the fact of and date of death. Linkage to the PBS was performed to obtain records of all medicines dispensed to patients undergoing a joint replacement procedure. Patients were included if they had undergone either a THA (119,076 patients, 131,336 procedures) or TKA (182,445 patients, 215,712 procedures) with a primary diagnosis of osteoarthritis, performed between 2013 and 2017. We excluded patients with missing ASA information (THA: 3% [3055 of 119,076] TKA: 2% [4095 of 182,445]). This left 127,761 primary THA procedures performed in 116,021 patients (53% [68,037 of 127,761] were women, mean age 68 ± 11 years) and 210,501 TKA procedures performed in 178,350 patients (56% [117,337 of 210,501] were women, mean age 68 ± 9 years) included in this study. Logistic regression models were used to determine the concordance of the ASA and Rx-Risk scores and 30-day and 90-day postoperative mortality. The Spearman correlation coefficient (r) was used to estimate the correlation between the ASA score and Rx-Risk score. All analyses were performed separately for THAs and TKAs. We found both the ASA and Rx-Risk scores had high concordance with 30-day mortality after THA (ASA: c-statistic 0.83 [95% CI 0.79 to 0.86] Rx-Risk: c-statistic 0.82 [95% CI 0.79 to 0.86]) and TKA (ASA: c-statistic 0.73 [95% CI 0.69 to 0.78] Rx-Risk: c-statistic 0.74 [95% CI 0.70 to 0.79]). Although both scores were strongly associated with death, their correlation was moderate for patients undergoing THA (r = 0.45) and weak for TKA (r = 0.38). However, the median Rx-Risk score did increase with increasing ASA score. For ex le, for THAs, the median Rx-Risk score was 1, 3, 5, and 7 for ASA scores 1, 2, 3, and 4, respectively. For TKAs, the median Rx-Risk score was 2, 4, 5, and 7 for ASA scores 1, 2, 3, and 4, respectively. The ASA physical status and RxRisk were associated with 30-day and 90-day mortality however, the scores were only weakly to moderately correlated with each other. This suggests that although both scores capture a similar level of patient illness, each score may be capturing different aspects of health. The Rx-Risk may be used as a complementary measure to the ASA score. Level III, therapeutic study.
Publisher: Elsevier BV
Date: 10-2023
Publisher: Elsevier BV
Date: 07-2019
Publisher: Swansea University
Date: 07-12-2020
Abstract: IntroductionTo enhance the value of the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) we recently linked these data with administrative datasets including, Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). Understanding the validity of administrative data is important in establishing the reliability of these data for informing clinical practice and policy. Objectives & ApproachThe study objective was to determine the validity of MBS data for capturing the occurrence of a joint replacement procedure. Using the AOANJRR procedures as the gold standard, we determined the sensitivity of the MBS data in correctly identifying hip joint replacement procedures. ResultsOf the 178,047 patients with a single primary total hip replacement occurring in a private hospital setting and recorded in the AOANJRR, 76% had a same-day MBS service claim indicative of that procedure, 2% had MBS procedures within +/- 7 days of the procedure while 18% had no MBS procedure codes indicative of a total hip joint replacement procedure. Of the procedures with no total hip MBS codes, 2% had MBS procedures codes indicating a total knee procedure, 1.7% had MBS procedure codes indicating a revision hip on that day and 13% of procedures had an in-hospital MBS hip anaesthetic administration code claimed on that day. Conclusion / ImplicationsGiven the increasing application of MBS data to describe health service use it is important to understand the validity of these data for identifying procedures undertaken in the private hospital setting. Using validated, gold standard data captured by the AOANJRR we identified that MBS data likely underestimate the occurrence of total hip replacement procedures. In addition, some MBS procedure codes are misattributed to other procedure types such as knee procedures and revision procedures.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2020
Publisher: Oxford University Press (OUP)
Date: 03-05-2023
Abstract: This review aimed to investigate the effectiveness of nurse-led interventions vs. usual care on hypertension management, lifestyle behaviour, and patients’ knowledge of hypertension and associated risk factors. A systematic review with meta-analysis was conducted following Joanna Briggs Institute (JBI) guidelines. MEDLINE (Ovid), EmCare (Ovid), CINAHL (EBSCO), Cochrane library, and ProQuest (Ovid) were searched from inception to 15 February 2022. Randomized controlled trials (RCTs) examining the effect of nurse-led interventions on hypertension management were identified. Title and abstract, full text screening, assessment of methodological quality, and data extraction were conducted by two independent reviewers using JBI tools. A statistical meta-analysis was conducted using STATA version 17.0. A total of 37 RCTs and 9731 participants were included. The overall pooled data demonstrated that nurse-led interventions may reduce systolic blood pressure (mean difference −4.66 95% CI −6.69, −2.64 I2 = 83.32 31 RCTs low certainty evidence) and diastolic blood pressure (mean difference −1.91 95% CI −3.06, −0.76 I2 = 79.35 29 RCTs low certainty evidence) compared with usual care. The duration of interventions contributed to the magnitude of blood pressure reduction. Nurse-led interventions had a positive impact on lifestyle behaviour and effectively modified diet and physical activity, but the effect on smoking and alcohol consumption was inconsistent. This review revealed the beneficial effects of nurse-led interventions in hypertension management compared with usual care. Integration of nurse-led interventions in routine hypertension treatment and prevention services could play an important role in alleviating the rising global burden of hypertension. PROSPERO: CRD42021274900
Publisher: Swansea University
Date: 07-12-2020
Abstract: IntroductionMonitoring of joint replacement (JR) data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) has reduced revision rates and improved surgical practice. Outcome assessment post-arthroplasty is limited however, to revision (reoperation) surgery and mortality outcomes. The AOANJRR National Data Linkage project seeks to broaden the scope of outcomes investigation in Australia by linking registry and health administrative datasets. Objectives and ApproachUsing linked registry and administrative data, the project seeks to describe and quantify national/regional trends and variation in major complications (infection, dislocation, arthrofibrosis, chronic pain, venous thromboembolism, cardiac events), malignancy and health service utilisation (readmissions, emergency encounters and inpatient rehabilitation) following hip, knee and shoulder joint replacement surgery. Evidence will be generated on how these outcomes are associated with and vary according to patient, surgical, implant, hospital and pharmacological factors. As Australia lacks a national identifier, seven linkage agencies are probabilistically linking AOANJRR hip, knee and shoulder replacement data (1999-2017) with 20 datasets. Datasets include government-subsidised health services, procedural and prescription data. Hospital separations and emergency attendance data from Australia’s eight jurisdictions together with national cancer registry and rehabilitation service data are also planned for linkage. Linked data are maintained in a secure remote access computing environment. ResultsTo date, national Medicare Benefits Schedule, Pharmaceutical Benefits Scheme and the Australian Cancer Database data have been linked with ,000 AOANJRR patients, representing 607.6 million health service records (1999-2018), 467.7 million prescriptions (2002-2018) and 184,000 cancer records, respectively. Remaining linked data will be available in mid-2020. Some initial summary results across a selected range of studies will be presented. Conclusion / ImplicationsThis national data-linkage program will identify areas for improvement in joint replacement surgery and modifiable risk factors contributing to poor patient outcomes.
Publisher: Wiley
Date: 07-09-2023
DOI: 10.1002/PDS.5522
Abstract: Infection is a major complication following joint replacement (JR) surgery. However, little data exist regarding antibiotic utilisation following primary JR and how use changes with subsequent revision surgery. This study aimed to examine variation in antibiotic utilisation rates before and after hip replacement surgery in those revised for infection, revised for other reasons and those without revision. This retrospective cohort analysis used linked data from the Australian Orthopaedic Association National Joint Replacement Registry and Australian Government Pharmaceutical Benefits Scheme. Patients were included if undergoing total hip replacement (THR) for osteoarthritis in private hospitals between 2002 and 2017. Three groups were examined: primary THR with no subsequent revision (n = 102 577), primary THR with a subsequent revision for reasons other than periprosthetic joint infection (PJI) (n = 3156) and primary THR with a subsequent revision for PJI (n = 520). Monthly antibiotic utilisation rates and prevalence rate ratios (PRRs) with 95% confidence intervals (CIs) were calculated in the 2 years pre- and post-THR. Prior to primary THR antibiotic utilisation was 9%-10%. After primary THR, antibiotic utilisation rates were higher among patients revised for PJI (PRR 1.69, 95% CI 1.60-1.79) compared to non-revised patients, while the utilisation rate was lower in patients revised for reasons other than infection (PRR 0.96, 95% CI 0.93-0.98). For those revised for infection, antibiotic utilisation post-revision surgery was two times higher than those revised for other reasons (PRR 2.16, 95% CI 2.08-2.23). Utilisation of injectable antibiotics including, vancomycin, flucloxacillin and cephazolin was higher in those revised for PJI patients 0-2 weeks following surgery but not in those revised for other reasons compared to the non-revised group. Ongoing antibiotic utilisation after primary surgery may be an early signal of problems with the THR and should be a prompt for primary care physicians to refer patients to specialists for further appropriate investigations and management.
Publisher: Wiley
Date: 06-12-2021
DOI: 10.1111/CTR.14151
Publisher: Elsevier BV
Date: 07-2023
Publisher: Oxford University Press (OUP)
Date: 23-01-2023
Abstract: To consolidate the evidence on the effectiveness of activity-monitoring devices and mobile applications on physical activity and health outcomes of patients with cardiovascular disease who attended cardiac rehabilitation (CR) programmes. An umbrella review of published randomized controlled trials, systematic reviews, and meta-analyses was conducted. Nine databases were searched from inception to 9 February 2022. Search and data extraction followed the JBI methodology for umbrella reviews and PRISMA guidelines. Nine systematic reviews met the inclusion criteria, comparing outcomes of participants in CR programmes utilizing devices/applications, to patients without access to CR with devices/applications. A wide range of physical, clinical, and behavioural outcomes were reported, with results from 18 712 participants. Meta-analyses reported improvements in physical activity, minutes/week [standardized mean difference (SMD) 0.23, 95% confidence interval (CI) 0.10–0.35] and activity levels (SMD 0.29, 95% CI 0.07–0.51), and a reduction in sedentariness [risk ratio (RR) 0.54, 95% CI 0.39–0.75] in CR participants, compared with usual care. Of clinical outcomes, the risk of re-hospitalization reduced significantly (RR 0.49, 95% CI 0.27–0.89), and there was reduction (non-significant) in mortality (RR 0.27, 95% CI 0.05–1.54). From the behavioural outcomes, reviews reported improvements in smoking behaviour (RR 0.87, 95% CI 0.67–1.13) and total diet quality intake (RR 0.79, 95% CI 0.66–0.94) among CR patients. The use of devices/applications was associated with increase in activity, healthy behaviours, and reductions in clinical indicators. Although most effect sizes indicate limited clinical benefits, the broad consistency of the narrative suggests devices/applications are effective at improving CR patients’ outcomes.
Publisher: Oxford University Press (OUP)
Date: 12-04-2021
DOI: 10.1093/NDT/GFAB157
Abstract: Pregnancy in women receiving kidney replacement therapy (KRT) is uncommon, and trends and factors influencing fertility rates remain poorly defined. The Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) was linked to mandatory perinatal data sets (all births from 1991 to 2013, ≥20 weeks’ gestation) in four Australian jurisdictions. Overall, age- and era-specific fertility rates were calculated based on general and KRT population denominators. From 2 948 084 births, 248 babies were born to 168 mothers receiving KRT (37 babies born to 31 dialysed mothers 211 babies born to 137 transplanted mothers). Substantial agreement between ANZDATA and perinatal data sets was observed for birth events and outcomes. Transplanted women had higher fertility rates than dialysed women in all analyses, with 21.4 live births/1000 women/year [95% confidence interval (CI) 18.6–24.6] in transplanted women, 5.8 (95% CI 4.1–8.1) in dialysed women and 61.9 (95% CI 61.8–62.0) in the non-KRT cohort. Fertility rates for dialysed women rose in recent years. After adjusting for maternal age and treatment modality, Caucasian women had higher fertility rates, while women with pre-existing diabetes, or transplanted women with exposure to KRT for ≤3.0 years had lower rates. As expected, transplanted women with a pre-conception estimated glomerular filtration rate (eGFR) of & mL/min/1.73 m2 or transplant-to-pregnancy interval of & .0 year had lower fertility rates. Geographical location, socioeconomic status and primary disease (glomerulonephritis versus other) did not affect fertility rates. Reporting of births to ANZDATA is sufficiently accurate to justify ongoing data collection. Rising fertility rates in dialysed women may indicate permissive attitudes towards pregnancy. Treatment modality, ethnicity, diabetes, pre-conception eGFR, transplant-to-pregnancy interval and duration of KRT exposure were associated with fertility rates. These factors should be considered when counselling women with kidney disease about parenthood.
Publisher: Elsevier BV
Date: 05-2023
Publisher: Oxford University Press (OUP)
Date: 03-06-2019
DOI: 10.1093/NDT/GFZ090
Abstract: The US Kidney Donor Risk Index (KDRI) and the UK KDRI were developed to estimate the risk of graft failure following kidney transplantation. Neither score has been validated in the Australian and New Zealand (ANZ) population. Using data from the Australia and New Zealand Organ Donor (ANZOD) and Dialysis and Transplant (ANZDATA) Registries, we included all adult deceased donor kidney-only transplants performed in ANZ from 2005 to 2016 (n = 6405). The KDRI was calculated using both the US donor-only and UK formulae. Three Cox models were constructed (Model 1: KDRI only Model 2: Model 1 + transplant characteristics Model 3: Model 2 + recipient characteristics) and compared using Harrell’s C-statistics for the outcomes of death-censored graft survival and overall graft survival. Both scores were strongly associated with death-censored and overall graft survival (P 0.0001 in all models). In the KDRI-only models, discrimination of death-censored graft survival was moderately good with C-statistics of 0.63 and 0.59 for the US and UK scores, respectively. Adjusting for transplant characteristics resulted in marginal improvements of the US KDRI to 0.65 and the UK KDRI to 0.63. The addition of recipient characteristics again resulted in marginal improvements of the US KDRI to 0.70 and the UK KDRI to 0.68. Similar trends were seen for the discrimination of overall graft survival. The US and UK KDRI scores were moderately good at discriminating death-censored and overall graft survival in the ANZ population, with the US score performing slightly better in all models.
Publisher: Swansea University
Date: 07-12-2020
Abstract: IntroductionPatient comobidity at time of primary joint replacement (JR) impacts on outcomes including revision and mortality. Understanding changes in comorbidity profiles is important when assessing change in outcomes over time. Most arthroplasty registries have limited comorbidity information due to their minimum dataset. One approach to obtaining additional comorbidity data is linking registry data with national administrative data. Objectives and ApproachObjectives were to quantify pre-operative comorbidity profile of patients undergoing primary total hip replacement (THR) and total knee replacement (TKR) for osteoarthritis. Also, to examine temporal trends in in idual comorbidities for THR and TKR patients. National pharmaceutical dispensing data were linked with THR and TKR arthroplasty patients. Medication dispensing histories in 12-months preceding JR (2003-2017) for 237,333 THR and 394,965 TKR patients, were mapped to 47 comorbidity classes using the Rx-Risk-V measure - a pharmacy-based measure of comorbidity. Comorbidity scores were calculated by summing comorbidity categories for in idual patients. Trends in comorbidity scores/categories were described, with comorbidity information presented by PBS beneficiary category (concessional/general), stratified by age ( /≥65 years). ResultsMedian (interquartile range) comorbidity scores were higher in concessional patients ≥65y, THR:5(3-6), TKR:5(3-7) y,TKR:5(3-6) but not THR:4(2-6). Comparative scores for general patients (both ages) were THR:4(2-6) and TKR:3(2-5). Trends in median comorbidity scores were consistent across study period, THR:4- 5(concessional)/2-3(general) and TKR:4-5(concessional)/4(general). Commonly identified comorbidities in younger concessional THR patients were pain, measured by opioid use (62.4%), inflammation ain, measured by use of non-steroidal anti-inflammatories (62.2%), GORD (36.2%) and hypertension (36.1%). In idual comorbidities remained generally stable over time. However, increased patient proportions were seen in THR concessionals y for opioid pain (59.1%-71.1%), depression (24.5-42.5%), whilst inflammation ain (82.1-56.1%) and antiplatelet use (≥65y:23.5-9.2%) declined. Conclusion / Implicationsn THR or TKR patients no appreciable change in comorbidity score or comorbidity profile occurred over time. This suggests that improving JR outcomes over time are unlikely due solely to variation in patient comorbidity profiles.
No related grants have been discovered for Aarti Gulyani.