In order to improve care for total hip and knee arthroplasties (THA/TKA), hospitals may want to compare their performance with hospitals in other countries. Pooling data across countries also enable early detection of infrequently occurring safety issues. We therefore aimed to assess the between-hospital variation and definitions used for revision, readmission, and complications across countries. PubMed, Embase, Web of Science, Cochrane library, Emcare, and Academic Search Premier were searched from January 2009 to August 2020 for studies reporting on: (i) primary THA/TKA; (ii) revision, readmission, or complications; and (iii) between-hospital variation. Most recent registry reports of Network of Orthopedic Registries of Europe members were also reviewed. Two reviewers independently screened records, extracted data, and assessed the risk of bias using the Integrated quality Criteria for the Review Of Multiple Study designs tool for studies and relevant domains for registries. We assessed agreement for the following domains: (i) outcome definition; (ii) follow-up and starting point; (iii) case-mix adjustment; and (iv) type of patients and hospitals included. Between-hospital variation was reported in 33 (1 high-quality, 13 moderate-quality, and 19 low-quality) studies and 8 registry reports. The range of variation for revision was 0-33% for THA and 0-27% for TKA varying between assessment within hospital admission until 10 years of follow-up; for readmission, 0-40% and 0-32% for THA and TKA, respectively; and for complications, 0-75% and 0-50% for THA and TKA, respectively. Indicator definitions and methodological variables varied considerably across domains. The large heterogeneity in definitions and methods used likely explains the considerable variation in between-hospital variation reported for revision, readmission, and complications , making it impossible to benchmark hospitals across countries or pool data for earlier detection of safety issues. It is necessary to collaborate internationally and strive for more uniformity in indicator definitions and methods in order to achieve reliable international benchmarking in the future.

中文翻译：

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医院间 THA 和 TKA 表现差异的国际比较：这可能吗？包括 33 项研究和 8 份关节成形术登记报告的系统评价。

为了改善全髋关节和膝关节置换术 (THA/TKA) 的护理，医院可能希望将其绩效与其他国家的医院进行比较。跨国家汇集数据还可以及早发现不常见的安全问题。因此，我们旨在评估不同国家/地区用于翻修、再入院和并发症的医院间差异和定义。从 2009 年 1 月到 2020 年 8 月，对 PubMed、Embase、Web of Science、Cochrane 图书馆、Emcare 和 Academic Search Premier 进行了搜索，以报告以下方面的研究：(i) 初级 THA/TKA；(ii) 翻修、再入院或并发症；(iii) 医院间差异。还审查了欧洲骨科注册网络成员的最新注册报告。两名审稿人独立筛选记录，提取数据，并使用用于研究和注册相关领域的多项研究设计审查的综合质量标准评估偏倚风险。我们评估了以下领域的一致性：（i）结果定义；(ii) 后续行动和起点；㈢ 案件组合调整；(iv) 包括的患者类型和医院。33 项研究（1 项高质量、13 项中等质量和 19 项低质量）研究和 8 项注册报告报告了医院间差异。THA 的翻修变化范围为 0-33%，TKA 为 0-27%，从入院评估到 10 年随访期间变化；对于再入院，THA 和 TKA 分别为 0-40% 和 0-32%；对于并发症，THA 和 TKA 分别为 0-75% 和 0-50%。不同领域的指标定义和方法变量差异很大。所用定义和方法的巨大异质性可能解释了报告的翻修、再入院和并发症的医院间差异的巨大差异，因此无法对各国医院进行基准测试或汇集数据以及早发现安全问题。有必要进行国际合作，争取在指标定义和方法上更加统一，以便在未来实现可靠的国际基准。