Study: Many TKA, THA procedures are performed by low-volume surgeons
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Published results showed many total hip and knee arthroplasties are performed by low-volume surgeons more than 2 decades after the volume-outcome relationship was established for joint arthroplasty.
“We have known for more than 20 years that hospitals and surgeons that do more surgeries have fewer complications. Despite our knowing about the relationship between volume and outcomes, we found little evidence of consolidation,” Matthew A. Pappas, MD, MPH, FHM, research investigator at the Cleveland Clinic Center for Value-Based Care Research and staff physician in the department of hospital medicine at the Cleveland Clinic, told Healio.
Pappas and colleagues described volume trends and used mixed-effects models to relate annual surgeon and hospital volumes with 30-day complications or mortality among Medicare beneficiaries who underwent either TKA or THA from 2009 through 2015. Researchers tested for optimal volume cut points at both the hospital and surgeon level.
Among 60,997,586 claims, researchers identified 1,809,941 TKAs performed by 25,201 surgeons and 897,388 THAs performed by 18,793 surgeons. Results showed an overall mortality rate of 0.07% for patients undergoing TKA and 0.1% for patients undergoing THA, and a complication rate of 7.7% for patients undergoing TKA and 9.2% for patients undergoing THA. Researchers found a decline in complication rates for both procedures, with complications occurring in 9.1% of TKAs performed in 2009 and in 6% performed in 2015 and in 11% of THAs performed in 2009 and in 7.1% performed in 2015.
Researchers noted an inverse association between adjusted annual complication rates and volume for TKA and THA at both the surgeon level and hospital level. However, researchers found minimal consolidation between 2009 and 2015. After volumes of each case exceeded 260 per year, complications no longer declined, according to results. Researchers found surgeons operating at suboptimal volumes performed around 93% of THAs and 88% of TKAs.
“Joint replacements can improve a patient’s life by reducing joint pain and improving function. The field needs to make sure that patients throughout the country have access to joint replacement, but that the surgeons who do those procedures are doing the best job possible,” Pappas said. “If we consolidate too much, it will be harder for patients to access surgery. If we do not consolidate enough, the surgeries we do will have more complications than necessary. Our paper offers guidance so that orthopedics can reach as many patients, while causing as few complications, as possible.”
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Pappas MA, et al. J Arthroplasty. 2022;doi:10.1016/j.arth.2022.05.011.
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