A1 Refereed original research article in a scientific journal

Meta-analysis of individual registry results enhances international registry collaboration




AuthorsElizabeth W Paxton, Maziar Mohaddes, Inari Laaksonen, Michelle Lorimer, Stephen E Graves, Henrik Malchau, Robert S Namba, John Kärrholm, Ola Rolfson, Guy Cafri

PublisherTaylor and Francis Ltd

Publication year2018

JournalActa Orthopaedica

Journal name in sourceActa Orthopaedica

Volume89

Issue4

First page 369

Last page373

Number of pages5

ISSN1745-3674

eISSN1745-3674

DOIhttps://doi.org/10.1080/17453674.2018.1454383(external)

Web address https://www.tandfonline.com/doi/full/10.1080/17453674.2018.1454383(external)

Self-archived copy’s web addresshttps://research.utu.fi/converis/portal/detail/Publication/31574614(external)


Abstract

Background and purpose — Although common in medical research, meta-analysis has not been widely adopted in registry collaborations. A meta-analytic approach in which each registry conducts a standardized analysis on its own data followed by a meta-analysis to calculate a weighted average of the estimates allows collaboration without sharing patient-level data. The value of meta-analysis as an alternative to individual patient data analysis is illustrated in this study by comparing the risk of revision of porous tantalum cups versus other uncemented cups in primary total hip arthroplasties from Sweden, Australia, and a US registry (2003–2015).

Patients and methods — For both individual patient data analysis and meta-analysis approaches a Cox proportional hazard model was fit for time to revision, comparing porous tantalum (n = 23,201) with other uncemented cups (n = 128,321). Covariates included age, sex, diagnosis, head size, and stem fixation. In the meta-analysis approach, treatment effect size (i.e., Cox model hazard ratio) was calculated within each registry and a weighted average for the individual registries’ estimates was calculated.

Results — Patient-level data analysis and meta-analytic approaches yielded the same results with the porous tantalum cups having a higher risk of revision than other uncemented cups (HR (95% CI) 1.6 (1.4–1.7) and HR (95% CI) 1.5 (1.4–1.7), respectively). Adding the US cohort to the meta-analysis led to greater generalizability, increased precision of the treatment effect, and similar findings (HR (95% CI) 1.6 (1.4–1.7)) with increased risk of porous tantalum cups.

Interpretation — The meta-analytic technique is a viable option to address privacy, security, and data ownership concerns allowing more expansive registry collaboration, greater generalizability, and increased precision of treatment effects.


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