High-volume revision surgeons have better outcomes following revision total knee arthroplasty

Roof, Mackenzie A.; Sharan, Mohamad; Merkow, David; Feng, James E.; Long, William J.; Schwarzkopf, Ran

doi:10.1302/0301-620x.103b6.bjj-2020-2287.r1

Cited by 24 publications

(17 citation statements)

References 18 publications

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“…There is no consensus within the orthopaedic community to guide an acceptable outcome or benchmark following RTKA, however our results would support the opinion of centralized RTKA teams to improve patient outcomes. 23 Certainly, the pursuit of improved function, fewer complications, and greater patient reported satisfaction are goals of the orthopaedic community and the focus of future endeavours.…”

Section: Discussionmentioning

confidence: 99%

Assessment of patient satisfaction following revision total knee arthroplasty

Quinn

Jones

Randle

2023

ANZ Journal of Surgery

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Background Patient satisfaction is becoming an increasingly important measure of healthcare quality. Satisfaction following RTKA is poorly described within the literature, resulting in difficulty for clinicians to manage patient expectations and obtain informed consent. Methods We investigated postoperative satisfaction of RTKA patients by a single surgeon, using a single prosthesis, at a single institution. Patient satisfaction was assessed using structured telephone assessment questionnaires and review of orthopaedic/hospital records. The effect of patient and surgical characteristics on satisfaction was assessed using correlation coefficients and binary logistic regression in SPSS. Results Two hundred and two RTKAs were performed in 178 patients between 2004 and 2015 inclusive. One hundred and twenty‐four patients (143 RTKAs) were contactable to complete satisfaction assessment. Eighty‐five percent of patients were satisfied and would have the RTKA again, 8% were unsure, 7% would not. Mean reported satisfaction on a numerical scale (1–10) was 8.17 (range 1–10), with 74% of patients scoring 8 or above, and 35% of patients scoring 10. The Mahomed Satisfaction Scale outcomes demonstrated a mean score of 87.7. High positive correlation was found between assessment tools. Logistic regression analysis identified factors contributing to satisfaction included ROM, OKS, BMI, and surgical time. Conclusion This cohort demonstrated high patient satisfaction rate following RTKA, utilizing simple and reliable outcome measurement tools. We found a high positive correlation between methods of assessment, and moderate positive correlation between satisfaction and functional outcomes. These results contribute to the understanding of satisfaction in RTKA patients, which may assist in informing patients of expected post‐operative outcomes.

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Section: Discussionmentioning

confidence: 99%

Assessment of patient satisfaction following revision total knee arthroplasty

Quinn

Jones

Randle

2023

ANZ Journal of Surgery

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“…High-volume hospitals and surgeons are associated with improved outcomes, including reduced complication and readmission rates, following hip/knee revisions. 18,21 Perhaps more notable, however, is the data describing disparities in travel burden and access in a hypothetical scenario wherein patients change New York state hospitals for their revision hip/knee surgery. The study of 37,147 revision total joint arthroplasty patients identified increased travel distance for Hispanic patients who transferred care to the nearest higher volume institution from the lowest 50% by volume hospitals (OR 12.3) relative to nonHispanic counterparts.…”

Section: Discussionmentioning

confidence: 99%

“…The study sample included adult patients (≥18 y) who underwent elective gastrectomy, pneumonectomy/lobectomy, proctectomy, or revision hip/knee arthroplasty between January 1, 2010, and December 31, 2017. These procedures were chosen because they are high cost, associated with considerable morbidity, and frequently the focus of centralization policies 18–29. Three eligible complex procedures (esophagectomy, cystectomy, and pancreatectomy) were excluded as they were noted to be highly centralized in Maryland before GBR enactment (Supplemental Figure S1, Supplemental Digital Content 1, http://links.lww.com/SLA/E319 and Supplemental Table S1, Supplemental Digital Content 1, http://links.lww.com/SLA/E319).…”

Section: Methodsmentioning

confidence: 99%

“…These procedures were chosen because they are high cost, associated with considerable morbidity, and frequently the focus of centralization policies. [18][19][20][21][22][23][24][25][26][27][28][29] Three eligible complex procedures (esophagectomy, cystectomy, and pancreatectomy) were excluded as they were noted to be highly centralized in Maryland before GBR enactment (Supplemental Figure S1, Supplemental Digital Content 1, http://links.lww.com/SLA/E319 and Supplemental Table S1, Supplemental Digital Content 1, http://links.lww.com/SLA/ E319). 30 Emergency procedures were excluded given their noted association with increased costs and higher risk of major complications.…”

Section: Study Populationmentioning

confidence: 99%

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Is the Centralization of Complex Surgical Procedures an Unintended Spillover Effect of Global Capitation? – Insights from the Maryland Global Budget Revenue Program

Lin¹,

Shah

Swisher

et al. 2022

Annals of Surgery

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Objective: To determine if global budget revenue (GBR) models incent the centralization of complex surgical care. Summary Background: In 2014, Maryland initiated a statewide GBR model. While prior research has shown improvements in cost and outcomes for surgical care post-GBR implementation, the mechanism remains unclear. Methods: Utilizing state inpatient databases, we compared the proportion of adults undergoing elective complex surgeries (gastrectomy, pneumonectomy/lobectomy, proctectomies, and hip/knee revision) at high-concentration hospitals (HCHs) in Maryland and control states. Annual concentration, per procedure, was defined as hospital volume divided by state volume. HCHs were defined as hospitals with a concentration at least at the 75th percentile in 2010. We estimated the difference-in-differences (DiD) of the probability of patients undergoing surgery at HCHs before and after GBR implementation. Findings: Our sample included 122,882 surgeries. Following GBR implementation, all procedures were increasingly performed at HCHs in Maryland. States satisfied the parallel trends assumption for the centralization of gastrectomy and pneumonectomy/lobectomy. Post-GBR, patients were more likely to undergo gastrectomy (DiD: 5.5 p.p., 95% CI [2.2, 8.8]) and pneumonectomy/lobectomy (DiD: 12.4 p.p., 95% CI [10.0, 14.8]) at an HCH in Maryland compared with control states. For our hip/knee revision analyses, we assumed persistent counterfactuals and noted a positive DiD post-GBR implementation (DiD: 4.8 p.p., 95% CI [1.3, 8.2]). No conclusion could be drawn for proctectomy due to different pre-GBR trends. Conclusions: GBR implementation is associated with increased centralization for certain complex surgeries. Future research is needed to explore the impact of centralization on patient experience and access.

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“…This trend is creating an exceedingly large demand for these procedures. We have shown that higher volume revision surgeons have better outcomes when performing rTKA than lower volume surgeons, highlighting the necessity of keeping these surgeons interested and incentivized to provide this type of service to their patients [ 12 ]. Failure to appropriately incentivize surgeons to perform these procedures may lead to a dearth of orthopaedic surgeons willing and able to take on these complicated revisions.…”

mentioning

confidence: 99%