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High-volume hospitals experienced increase in elective TJA procedures
About 80% of the U.S. population lives near a high-volume hospital.
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Patients in the United States opted to undergo elective total hip or total knee arthroplasty at higher volume hospitals, according to a study. In addition, researchers found an inverse relationship between hospital volume and complication rates.
“In the U.S. in the past decade, there has been a prominent shift toward arthroplasties being done in high-volume hospitals,” Timothy Bhattacharyya, MD, head of Clinical and Investigative Orthopedics at the National Institute of Arthritis and Musculoskeletal and Skin Diseases at the National Institutes of Health, told Orthopedics Today. “About 10 years ago, it became clear that the outcomes from high-volume centers were better than outcomes from low-volume centers and as a result, patients have migrated to high-volume hospitals and that is without anybody forcing them or any sort of mandates or incentives.”
High- vs low-volume hospitals
In a lead article published in the Journal of Bone and Joint Surgery, Bhattacharyya and his colleagues used the National Inpatient Sample from 2000 to 2012 to quantify trends in the volume of total hip arthroplasties (THAs) and total knee arthroplasties (TKAs) performed. Researchers calculated county geographic and population data collected from the U.S. Census Bureau and the distance from hospitals to county centroids. Using Medicare Hospital Compare, researchers collected risk-standardized surgical complication rates and categorized the rates for the hospitals by volume.
Findings showed a marked increase in elective primary THAs and TKAs performed during the study period. The number of elective primary arthroplasties performed annually increased from 343,000 arthroplasties to 851,000 arthroplasties during the study period. In 2012, 65.5% of arthroplasties were performed at high-volume hospitals and 26.6% of arthroplasties were performed at very high-volume hospitals. Researchers defined low-volume, intermediate, high-volume and very high-volume hospitals as less than 100, 100 to 399, 400 to 999 and more than 1,000 TKAs and THAs performed annually, respectively.
According to researchers, there was an annual decrease in the proportion of arthroplasties performed in low-volume hospitals. This figure went from 17.9% to 5.4%. The lowest complication rates were seen in high-volume hospitals (2.7 per 100), whereas the highest complication rates were seen in low-volume hospitals (3.6 per 100). Analysis results showed 81.9% of the U.S. population lived within 50 miles of a high-volume hospital.
Transforming hospitals
Bhattacharyya noted it was surprising that no ceiling effect was observed among very high-volume hospitals, which continued to see gains in lower complication rates. As hospitals gained more patients undergoing arthroplasty, “a fairly large number of hospitals were able to transform themselves in order to take on a much higher volume of patients,” he added.
“The number of hospitals is actually fixed,” Bhattacharyya said. “The number of hospitals in the United States has not changed, and yet, we are doing twice as many joint replacements. The way that we are doing twice as many joint replacements is that the [people] who are doing well are getting more.” – by Monica Jaramillo and Casey Tingle
- Reference:
- Laucis NC, et al. J Bone Joint Surg Am. 2016;doi:10.2106/JBJS.15.00399.
- For more information:
- Timothy Bhattacharyya, MD, can be reached at 10215 Fernwood Rd., #506, Bethesda, MD 20817; email: timothy.bhattacharyya@nih.gov.
Disclosure: Bhattacharyya reports no relevant financial disclosures.