Objective To assess the operational and quality management status of outpatient multi-disciplinarytreatment (MDT) services in tertiary hospitals nationwide, identify core quality indicators and key influencing factors for their development. Methods A multicenter cross-sectional survey was conducted from November to December 2024 among tertiary medical institutions nationwide that had implemented outpatient MDT services. The entropy weight method was employed to calculate the weights of outpatient MDT quality indicators, objectively determining their importance ranking. Meanwhile, a 10-point Likert scale was used to systematically evaluate internal and external factors influencing the development of outpatient MDT services. Results A total of 521 hospitals were surveyed. Among them, there were 458 tertiary hospitals (87.9%) and 63 tertiary hospitals (12.1%). Gaps remain in key aspects of outpatient MDT quality management: 295 institutions (56.6%) lacked clear inclusion criteria for MDT case discussions; 159 (30.5%) had not implemented an electronic medical record system for outpatient MDT; and 130 (25.0%) had not established an assessment mechanism for outpatient MDT. Objective weighting via the entropy weight method revealed the top three indicators by weight: “whether outpatient MDT regulations have been formulated” (27.287%), “whether a standard approval process exists for establishing an MDT” (19.079%), and “whether a team secretary is assigned” (15.433%). Analysis of influencing factors showed that among external factors, “medical insurance policies” had the most significant impact, while among internal factors, “departmental emphasis/physician awareness” was most prominent. Conclusions The core indicators of outpatient MDT quality management were screened by entropy weighting method and the key influencing factors were explored using Liszt scoring method. This provides an objective basis for healthcare administration to standardize outpatient MDT services and enhance operational quality and efficiency.
ObjectiveTo investigate the accuracy, safety, and short-term effectiveness of a domestic robot-assisted system in total knee arthroplasty (TKA) by a multicenter randomized controlled trial. Methods Between December 2021 and February 2023, 138 patients with knee osteoarthritis who received TKA in 5 clinical centers were prospectively collected, and 134 patients met the inclusion criteria were randomly assigned to either a trial group (n=68) or a control group (n=66). Seven patients had lost follow-up and missing data, so they were excluded and the remaining 127 patients were included for analysis, including 66 patients in the trial group and 61 patients in the control group. There was no significant difference (P>0.05) in gender, age, body mass index, side, duration of osteoarthritis, Kellgren-Lawrence grading, preoperative Knee Society Score (KSS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score between the two groups. The trial group completed the TKA by domestic robot-assisted osteotomy according to the preoperative CT-based surgical planning. The control group was performed by traditional osteotomy plate combined with soft tissue release. Total operation time, osteotomy time of femoral/tibial side, intraoperative blood loss, and postoperative complications were recorded and compared between the two groups. The radiographs were taken at 5 and 90 days after operation, and hip-knee-ankle angle (HKA), lateral distal angle of femur (LDFA), and posterior tibial slope (PTS) were measured. The difference between the measured values of the above indexes at two time points after operation and the preoperative planning target values was calculated, and the absolute value (absolute error) was taken for comparison between the two groups. The postoperative recovery of lower limb alignment was judged and the accuracy was calculated. KSS score and WOMAC score were used to evaluate the knee joint function of patients before operation and at 90 days after operation. The improvement rates of KSS score and WOMAC score were calculated. The function, stability, and convenience of the robot-assisted system were evaluated by the surgeons. ResultsThe total operation time and femoral osteotomy time of the trial group were significantly longer than those of the control group (P<0.05). There was no significant difference in the tibial osteotomy time and the amount of intraoperative blood loss between the two groups (P>0.05). The incisions of both groups healed by first intention after operation, and there was no infection around the prosthesis. Nine patients in the trial group and 8 in the control group developed lower extremity vascular thrombosis, all of which were calf intermuscular venous thrombosis, and there was no significant difference in the incidence of complications (P>0.05). All patients were followed up 90 days. There was no significant difference in KSS score and WOMAC score between the two groups at 90 days after operation (P>0.05). There was significant difference in the improvement rate of KSS score between the two groups (P<0.05), while there was no significant difference in the improvement rate of WOMAC score between the two groups (P>0.05). Radiological results showed that the absolute errors of HKA and LDFA in the trial group were significantly smaller than those in the control group at 5 and 90 days after operation (P<0.05), and the recovery accuracy of lower limb alignment was significantly higher than that in control group (P<0.05). The absolute error of PTS in the trial group was significantly smaller than that in the control group at 5 days after operation (P<0.05), but there was no significant difference at 90 days between the two groups (P>0.05). The functional satisfaction rate of the robot-assisted system was 98.5% (65/66), and the satisfaction rates of stability and convenience were 100% (66/66). ConclusionDomestic robot-assisted TKA is a safe and effective surgical treatment for knee osteoarthritis, which can achieve favorable lower limb alignment reconstruction, precise implant of prosthesis, and satisfactory functional recovery.
