Given the time and budgetary constraints of a pharmacy residency project, it was feasible to retrospectively audit a total of about 120 medical records from any of the 3 hospitals in the region, as a convenience sample. Approval was granted by the Conjoint Health Research Ethics Board of the University of Calgary on February 9, 2006, and data were collected and summarized by mid-June 2006.
Of the 44 orthopedic surgeons on staff in the region, 15 focused on knee and hip arthoplasty and had a primary affiliation with the Subdivision of Joint Reconstruction. The practice of these subspecialists was of most interest, and each was assigned a unique identifier letter to allow stratification by surgeon. The hospital site where each procedure was performed was deemed to be of lesser importance, so there was no stratification by site; instead, the practice of each of the surgeons was simply followed sequentially, regardless of where the operations were performed. Apcalis Oral Jelly
Working with a proposed maximum of 120 charts for review, 4 knee and 4 hip procedures were sought for each of the 15 surgeons. The Department of Quality, Safety and Health Information (QSHI) was asked to provide a list of all adult patients who had undergone a primary, cemented total hip (dual component, using bone cement alone or combined with bone graft) or knee (tri-component, using bone cement alone or combined with bone graft) arthroplasty procedure at any of the 3 tertiary care hospitals, and a list of patients’ medical record numbers was generated. Given the high probability of seasonal coverage, the summer months were avoided, and a 3-month block of time (March to May 2006) was chosen; this period was recent, and there was also a high probability that medical records would be complete and accessible. Consecutive operative reports from the list were screened and selected according to the surgeon who had performed the arthoplasty (not the admitting or discharging surgeon) and the procedure that had been performed (as recorded in operating room data, rather than QSHI data) until data on 8 procedures per surgeon had been found. Each of the medical records was reviewed by a single investigator (C.C.) to determine the patient’s age, sex, weight, height, allergy status, and baseline creatinine level; the use of bone cement (type, quantity, and concentration of antibiotic if an ABC was used); the hospital site of the procedure; the patient’s history of smoking tobacco and comorbid conditions (diabetes mellitus, rheumatoid arthritis, inflammatory bowel disease, chronic renal insufficiency); and the patient’s use of concurrent immunosuppressive medications. cialis 10 mg
The data were entered into a Microsoft Excel spreadsheet, which was used to generate descriptions of aggregate data and to allow comparison of the various patient characteristics. A 2-tailed Fisher’s exact test for significance was applied to compare unpaired groups, as appropriate. No external funding was secured for this descriptive, exploratory audit.