Specialty orthopedic hospitals have lower adverse TKA, THA outcome rates vs. general hospitals

Specialty orthopedic hospitals admitted patients with fewer medical comorbidities, but still performed better after adjusting for such factors.

Compared to general hospitals, specialty orthopedic hospitals serve a healthier population of Medicare patients, a new study found. However, Medicare patients who receive total hip or knee arthroplasty at specialty hospitals have a 40% lower risk of postoperative complications, the study authors noted.

"The findings were somewhat surprising and important," Peter Cram, MD, MBA, lead author of the study, said in a University of Iowa press release.

"We suspected that specialty orthopedic hospitals were selecting low-risk patients for admission and that is what our analysis found. But we also found that complications were less common in specialty hospitals even after accounting for the types of patients each hospital admitted — this was quite surprising," he said.

Cram and colleagues at the University of Iowa Carver College of Medicine, Iowa City, reviewed records for 51,788 Medicare beneficiaries treated with total hip arthroplasty (THA) and 99,765 patients treated with total knee arthroplasty (TKA) between 1999 and 2003. Patients underwent surgery at one of 38 specialty orthopedic hospitals or 517 general hospitals in the same markets.

All patients were aged 65 years or older, and averaged 75 years of age at surgery, according to the study, published in the American edition of the Journal of Bone and Joint Surgery.

The researchers found that, compared to general hospitals, specialty orthopedic hospitals admitted patients with fewer medical comorbidities, such as obesity, heart failure and diabetes. "Yet even after you adjust for these factors, so that you can compare apples to apples, specialty orthopedic hospitals still seem to have a significant and unexpected edge," Cram said in the press release.

However, the he noted that their findings should be interpreted cautiously.

"While our study provides new information on the quality of care in specialty hospitals, it is important that these findings be replicated in populations other than Medicare patients and using other approaches to measure complications than claims data," Cram wrote.

"In addition, our study focused on surgical complications and did not analyze other important markers such as patient satisfaction, costs and symptom relief," he noted.

"One potential explanation for the better outcomes seen in orthopedic specialty hospitals in the current study is that specialization by hospitals can offer real advantages, particularly when it comes to surgical procedures," he said in the release.

For more information:
Cram P, Rosenthal GE, Vaughan-Sarrazin MS, Wolf B, Katz JN. A comparison of total hip and knee replacement in specialty and general hospitals. J Bone Joint Surg Am. 2007;89-A:1675-1684.