Data-Driven Tool Shows Diabetes is Not a Barrier to Joint Replacement Surgery

Around 2 million joint replacement surgeries are carried out around the world each year. Until now, pre-operative risk assessments have been based on the information provided by the patient and relied on the surgeon’s own clinical experience and judgement. Developed by the Coxa Hospital for Joint Replacement, the Orthopedist’s Risk Assessment Tool (ORA) is a unique calculator that produces an accurate, evidence-based assessment of surgical risks tailored to the individual circumstances of each patient. 

The tool allows surgical teams to accurately identify patients who are not candidates for joint replacement surgery due to the risks involved, as well as those who need to make health improvements before surgery can go ahead. The analyses generated by the ORA tool are based on data gathered from almost 40,000 patients. 

“We know that the risk of mortality can rise significantly when two or more of certain variables are present. This sort of risk may be difficult to identify just by looking at the patient’s medical records, but the ORA tool will pick up on it on the clinician’s behalf,” explaines Antti Eskelinen, Research Director at Coxa. 

The risk assessment tool has also played a key role in revealing new information about the risks associated with joint replacement surgery. For example, diabetes is long believed to have been associated with an increased risk of post-operative infection. The data contained in ORA show that diabetes on its own does not constitute a significant risk factor, however, while an increased BMI is also not as significant a risk factor as previously thought. 

Data-Driven and Patient-Centred Decision Making 
Until now, orthopaedic surgeons have had to rely on their own clinical experience when conducting pre-operative risk assessments. As the relevant information regarding risks has been provided to patients verbally in the clinic setting, surgeons have found that it has in some cases been difficult to discuss the risks effectively and to ensure that patients are fully committed to the lifestyle and other changes required before the operation can go ahead. 

“In our experience, patients are more likely to engage with their treatment if the clinicians caring for them can quantify the risks, including showing what the risks look like relative to other patients. The benefit of ORA is that it makes this information available in an accessible and easy to understand format. When it comes to risk factors that patients do have control over, it is easier to help motivate the patients to make the necessary changes when they have first seen the statistical numbers and graphs for themselves,” Antti Eskelinen explains. 

The ORA tool also supports clinicians in identifying the key risk factors. 

The ORA risk assessment tool is based on data from almost 40,000 joint replacement patients, gathered over a period of 15 years. The 550 pre-operative variables have been drawn up on the basis of patient surveys, prescription history, laboratory results, clinical examinations and formal diagnoses. The tool generates an assessment of one-year post-operative infection risk, two-year post-operative mortality risk and the risk of further surgery after two or more years. ORA has been developed in collaboration with digital transformation company Solita. 

Coxa Hospital for Joint Replacement is the only hospital in Finland specializing exclusively in joint replacement surgery, and it is one of the leading hospitals of its kind in Europe. In 2018, the hospital carried out more than 4,500 operations. Its staff specializes in joint replacement surgeries and are leading practitioners in their fields.