The what, when and how of orthopaedic registers: an introduction into register-based research

Abstract

Establishment of orthopaedic registers started in 1975 and many registers have been initiated since. The main purpose of registers is to collect information on patients, implants and procedures in order to monitor and improve the outcome of the specific procedure. Data validity reflects the quality of the registered data and consists of four major aspects: coverage of the register, registration completeness of procedures/patients, registration completeness of variables included in the register and accuracy of registered variables. Survival analysis is often used in register studies to estimate the incidence of an outcome. The most commonly used survival analysis is the Kaplan–Meier survival curves, which present the proportion of patients who have not experienced the defined event (e.g. death or revision of a prosthesis) in relation to the time. Depending on the research question, competing events can be taken into account by using the cumulative incidence function. Cox regression analysis is used to compare survival data for different groups taking differences between groups into account. When interpreting the results from observational register-based studies a number of factors including selection bias, information bias, chance and confounding have to be taken into account. In observational register-based studies selection bias is related to, for example, absence of complete follow-up of the patients, whereas information bias is related to, for example, misclassification of exposure (e.g. risk factor of interest) or/and outcome. The REporting of studies Conducted using Observational Routinely-collected Data guidelines should be used for studies based on routinely-collected health data including orthopaedic registers. Linkage between orthopaedic registers, other clinical quality databases and administrative health registers may be of value when performing orthopaedic register-based research. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180097