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Hospitals more specialized in orthopedic surgery show better outcomes for hip and knee replacement
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A recent study of Medicare data by University of Iowa investigators indicates that hospitals with a higher degree of orthopedic specialization provide better outcomes for patients undergoing hip or knee replacement surgery.
The findings, which appear in the online version of the British Medical Journal, were based on a retrospective study of nearly 1.3 million Medicare beneficiaries aged 65 years and older who had hip or knee replacement procedures between 2001 and 2005 at 3,818 U.S. hospitals. The investigators grouped the hospitals into five categories according to their degree of orthopedic specialization. Orthopedic procedures accounted for 10.5% of admissions at the average hospital, while they represented 14.5% or more of the admissions in the most specialized group.
Complications
The investigators discovered fewer postoperative complications, such as blood clots, infections, heart problems and death among the more specialized hospitals, according to a University of Iowa press release.
“The findings suggest that more specialized hospitals have better outcomes even after we account for the type of patients each hospital cares for and the number of hip and knee replacement surgeries that each hospital performs,” Tyson Hagen, MD, the lead author of the study, stated in the release. “While specialization appears to be an important indicator or quality, it is just one factor that patients might want to consider along with other important factors, such as how close the hospital is to home.”
Mortality rates
The investigators discovered that the rate of death within the first 90 postoperative days for patients undergoing hip or knee replacement was twice as high at the least specialized hospitals compared to the most specialized hospitals. They also found that a1% higher rate of postoperative infection at the least specialized hospitals compared to the most specialized centers.
In addition, the investigators found that the more specialized hospitals treated patients who were in better health, and fewer women and African-Americans than the least specialized hospitals.
“Learning more about orthopedic specialization could help us better understand how to organize care an take ideas from more specialized hospitals to less specialized hospitals, and result in better outcomes all around,” Peter Cram, MD, a senior author of the study stated in the release.
Reference:
Hagen TP, Vaughan-Sarrazin MS, Cram P. Relation between hospital orthopaedic specialisation and outcomes in patients aged 65 and older: retrospective analysis of US Medicare data. BMJ. Published online 2010 Feb 11.
