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Risk-adjustment models allow more accurate comparison of outcomes with TJA registry data
Larger populations, more patient-reported outcomes are needed.
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Risk-adjustment models can be used to more accurately compare surgeons, hospitals and devices using registry data for total joint arthroplasty procedures, according to study results.
“This study demonstrates the importance of adjusting for differences between providers in the underlying risk factors of the patient population they treat,” Nelson F. SooHoo, MD, professor for the Department of Orthopedic Surgery at University of California, Los Angeles in Santa Monica, Calif. told Orthopedics Today. “This study demonstrates both feasibility and importance of this type of risk-adjustment.”
Study design
SooHoo, Kevin J. Bozic, MD, MBA, and colleagues analyzed the 90-day complication rates of 9,960 patients who underwent total joint arthroplasty (TJA) at one of 22 medical centers enrolled in the California Joint Replacement Registry (CJRR). Multivariable logistic risk models were used to compare rates of postoperative complications, and a risk-adjustment model was used to determine patient predictors for postoperative complications and to calculate risk-adjusted complication rates from the hospitals.
Findings showed the mean unadjusted complication rate following TJA was 7.1%. According to the multivariable logistic risk model, the strongest predictors for complication rates were the American Society of Anesthesiologists class and age, followed by congestive heart failure and peripheral artery disease.
Investigators found three hospitals had significantly worse complication rates than expected. However, one hospital had better complication rates than expected after risk adjustment.
Importance of joint registries
“Our ability to quantify and adjust for patient factors, like age and comorbidities, will enable a level playing field for comparing patient outcomes across providers,” said Bozic, who is professor and chair of the Department of Surgery and Perioperative Care, Dell Medical School at University of Texas in Austin, Texas.
Both physicians noted this will assist in reassuring surgeons and hospitals will not be penalized for treating patients with higher risks and prevent ‘cherry picking’ from the healthy patients.
“We did not find statistically significant associations between gender or race and outcomes,” SooHoo said. “This may be due to the large sample sizes needed to detect differences given that outcomes are relatively rare. This will be something the CJRR will need to continue to analyze as our experience and numbers of enrolled patients increases.”
They added surgeries performed have huge functional benefits and the data from joint registries is critical for providing proof of their benefits to patients, employers, insurers and policy-makers.
Both physicians said considering CJRR’s value will only be fully realized with a larger population, they have partnered with the American Joint Replacement Registry to achieve this goal. SooHoo encourages surgeons to engage with these joint registries, as data provided would strengthen their voice and help to drive health care policies.
Another limitation they noted is a general lack of patient-reported outcomes in total joint registries. Readmission rates are low overall and patients have demonstrated limited interest in public reporting of these infrequent complications.
“Our focus moving forward is to report risk-adjusted patient-reported outcomes that center on the outcomes of most interest to patients: namely, pain, function and quality of life,” Bozic said. by Monica Jaramillo
- Reference:
- SooHoo NF, et al. J Arthroplasty. 2016; doi: 10.1016/j.arth.2015.09.041.
- For more information:
- Nelson F. SooHoo, MD, can be reached at UCLA Medical Center, 1250 16th St., Suite 3142Santa Monica, CA 90404; email: nsoohoo@mednet.ucla.edu.
- Kevin J. Bozic, MD, MBA, can be reached at Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, 1912 Speedway, Austin, TX 78712; email: kevin.bozic@austin.utexas.edu.
Disclosures: SooHoo reports no relevant financial disclosures. Bozic reports he is the vice chair of the board of directors for the American Joint Replacement Registry.