Higher risk of complications after joint replacement seen at low-volume hospitals

Patients who undergo elective total hip or total knee arthroplasty at hospitals with lower surgical volume have a higher postoperative risk of venous thromboembolism and mortality.

The authors suggest in the study — published in Arthritis & Rheumatism — that postoperative complications for joint replacement surgery at low-volume sites could be reduced through the modification of systems and procedures used both preoperative and postoperatively, according to a Wiley-Blackwell press release.

“With the large number of elective arthroplasty in the United States, it is important to understand the impact of perioperative and postoperative medical complications on the success of joint replacement surgery,” lead author Jasvinder Singh, MBBS, MPH, stated in the release. “Possible cardiac complications, blood clots or infections increase patient morbidity and mortality risk, which can lead to higher health care utilization and costs.”

To explore the relationship between hospital procedure volume and surgical outcomes following primary total hip or total knee replacements, the study authors used the Pennsylvania Health Care Cost Containment Council database to identify the number of patients who underwent total hip replacement (10,187) and total knee replacement (19,418) surgery in 2002 in Pennsylvania.

Hospital volume was categorized by annual performance of less than 25 surgeries, 26 to 100 surgeries, 101 to 200 surgeries (defined as low-volume hospitals), or greater than 200 surgeries (defined as high-volume hospitals). Patients who underwent primary total hip arthroplasty at low-volume hospitals were reported to be more likely to develop pulmonary embolism within 30 days postoperatively than those patients who underwent surgery at a high-volume hospital. Furthermore, 1-year mortality was higher for patients who underwent total hip replacement at low-volume hospitals.

Patients 65 years of age and older were reported has having significantly higher odds for 1-year mortality after undergoing total knee arthroplasty at low-volume hospitals when compared to the odds found in higher volume hospitals. Causes of complications at low-volume hospitals, the authors theorized, could be connected to hospital procedures, as well as perioperative and postoperative care processes.

“Further studies are needed to investigate whether the underlying reasons for poor surgical outcomes at low-volume hospitals are modifiable and which interventions may reduce complications for patients at these facilities,” Singh stated.

Reference:

Singh JA, Kwoh CK, Boudreau RM, et al. Hospital volume and surgical outcomes after elective hip/knee arthroplasty: A risk adjusted analysis of a large regional database. Arthritis Rheum. 2011 Jun 7. doi: 10.1002/art.30390. Epub ahead of print.

Follow OrthoSuperSite.com on Twitter