Medical, surgical TJA complications in Medicare patients can be better managed

CHICAGO — When total joint arthroplasty surgeons share their successful practices, the overall complication rates of 3.6% with these procedures in Medicare patients stand to be reduced. Furthermore, such collaboration may lead to increased quality of care and outcomes, according to a speaker here at the American Academy of Orthopaedic Surgeons Annual Meeting.

“Risk stratified complication rates for primary hip and knee arthroplasty procedures demonstrate substantial variations across hospitals that cannot be accounted for by patient factors alone,” Daniel J. Berry, MD, said.

“Little is known about the rate and variation of complication rates for primary hip and knee arthroplasty across hospitals in the United States,” Berry said.

He noted that what is already known in this area concerns processes and not quality measures.

The multicenter study he was involved in used a CMS-sponsored and National Quality Forum-approved metric to look at hospital-level risk-standardized complications that are medical or surgical in nature in conjunction with primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). These are the same complications that U.S. hospitals will begin to be rated on this year, Berry added.

The regional variations were of particular interest to the investigators. They found distinct patterns from their study that included Medicare beneficiaries who underwent elective primary THA or TKA between 2008 and 2010.

“The factors that were most associated with complications are protein-calorie malnutrition with a relative risk (RR) of 2.7, end-stage renal disease with a RR of 1.4 and the association of more than one procedure during a hospitalization with the likelihood of having a complication is almost two-fold high, as well, and maybe not surprising to most of us,” Berry said.

Reference:

Bozic KJ SK. Paper #45. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 19-23, 2013; Chicago.

Disclosure: Berry receives royalties from DePuy for hip and knee products.