Increased Orthopedic Specialization Lowers Costs and Improves Outcomes in Total Joint Arthroplasty

Bockhorn, Lauren N.; Goytia, Robin N.; Laughlin, Mitzi S.; Patel, Anay

doi:10.1016/j.arth.2019.02.019

Cited by 16 publications

(16 citation statements)

References 28 publications

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“…Previous research has shown that regionalization of complex care and several kinds of orthopedic joint arthroplasty results in lower mortality and reduction in hospitalization time ( 21 , 22 , 23 , 24 , 25 ). This also leads to better value-based healthcare by lowering costs.…”

Section: Discussionmentioning

confidence: 99%

Is there a relationship between surgical volume and outcome for total elbow arthroplasty? A systematic review

et al. 2023

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Purpose: Total elbow arthroplasty (TEA) is rarely performed compared to other arthroplasties. For many surgical procedures, literature shows better outcomes when they are performed by experienced surgeons and in so-called ‘high-volume’ hospitals. We systematically reviewed the literature on the relationship between surgical volume and outcomes following TEA. Methods: A literature search was performed using the MEDLINE, EMBASE and CINAHL databases. The literature was systematically reviewed for original studies comparing TEA outcomes among hospitals or surgeons with different annual or career volumes. For each study, data were collected on study design, indications for TEA, number of included patients, implant types, cut-off values for volume, number and types of complications, revision rate and functional outcome measures. The methodological quality of the included studies was assessed using the Newcastle–Ottawa Scale. Results: Two studies, which included a combined 2301 TEAs, found that higher surgeon volumes were associated with lower revision rates. The examined complication rates did not differ between high- and low-volume surgeons. In one study, low-hospital volume is associated with an increased risk of revision compared to high-volume hospitals, but for other complication types, no difference was found. Conclusions: Based on the results, the evidence suggests that high-volume centers have a lower revision rate in the long term. No minimum amount of procedures per year can be advised, as the included studies have different cut-off values between groups. As higher surgeon- and center-volume, (therefore presumably experience) appear to yield better outcomes, centralization of total elbow arthroplasty should be encouraged.

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Section: Discussionmentioning

confidence: 99%

Is there a relationship between surgical volume and outcome for total elbow arthroplasty? A systematic review

et al. 2023

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“…High-volume specialty hospitals have been associated with lower costs, complications, total hospitalspecific charges, and readmissions in the Medicare population. 10,11 However, these findings are controversial as some studies have found high-volume facilities had higher Medicare inpatient payments and no differences in hospitalspecific charges but were less likely to have high-end cost outliers. 27 Prior state-level evidence found no correlation between inpatient costs and hospital volume.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] There is evidence for a correlation between surgical volume and value in THA, with high-volume centers associated with lower costs and improved outcomes. 10,11 The etiology of this is multifactorial; however, implant price plays a significant role in the overall inpatient costs to the hospital. [12][13][14][15] Much of the current literature examining costs, charges, and repayment utilizes national Medicare databases, 7 but there is limited evidence regarding patient-level costs at the state level.…”

mentioning

confidence: 99%

Comparison of Inpatient Charges between Primary and Revision Total Hip Arthroplasties: A Study of Trends within the New York's Statewide Planning and Research Cooperative System

Passano,

Simcox,

Anil

et al. 2023

The Journal of Hip Surgery

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The U.S. health care system continues to absorb greater costs for total hip arthroplasty (THA). The purpose of this study is to quantify inpatient charges for primary THA (pTHA) and revision THA (rTHA) and to review trends over the past decade. A New York statewide database was utilized to identify all inpatient elective pTHA and rTHA from 2010 to 2020. Nonelective indications were excluded. The primary outcome measure was total inpatient charges per encounter. Secondary outcomes included: accommodation charges, ancillary charges, and hospital THA volume. Subgroup analyses were performed based on rTHA indication and hospital volume. Total 256,879 pTHAs and 29,852 rTHAs were identified; 6,616 rTHAs were performed for instability, 5,976 for aseptic loosening, 5,155 for mechanical complications, 4,343 for infection, 3,014 for periprosthetic fracture, 1,427 for polyethylene wear, and 3,321 for other indications. Compared with pTHA, there were higher total, accommodation, and ancillary charges in the rTHA cohort (p < 0.001). High-volume centers achieved lower total charges for rTHA, lower accommodation charges for both cohorts, but higher ancillary charges for pTHA (p < 0.001). Between 2010 and 2020, total charges increased 46.6 and 76.2% for pTHA and rTHA, respectively. Inpatient costs of rTHA were significantly higher than that of pTHA. For rTHA, charges were highest for periprosthetic fracture and infection. Total inpatient charges of THA have greatly outpaced inflation over the past decade.

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“…A limitation of our study is that it was from a single hospital where the entire process of providing care for the high-volume joint arthroplasty surgeons was highly optimized to avoid delays [ 28 , 29 ]. Patients were nearly always well-prepared before the day of surgery, with their charts in order, all labs and studies resulted, consents on the chart, and any medical issues addressed before the day of surgery.…”

Section: Discussionmentioning

confidence: 99%

Briefest Time to Perform a Series of Preoperative Nerve Blocks in Multiple Patients: A Simulation Study

Epstein¹,

Dexter²,

Mojica³

et al. 2021

Cureus

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IntroductionTo mitigate first-case delays in operating rooms, sufficient additional time must be allotted when anesthesiologists perform preoperative nerve blocks in multiple patients who are scheduled as the initial cases of the day. We used spinal anesthetics performed in dedicated block rooms located just outside the operating room suite to estimate the briefest times needed to complete a series of spinal, epidural, peripheral, or other regional nerve blocks. We followed this approach because even though the studied hospital had a busy regional anesthesia service, sample sizes were insufficient and electronic data were not available to directly study the time to perform the many other nerve blocks they perform. MethodsWe studied a historical cohort of 8,462 adult patients undergoing spinal anesthesia between 2005 and 2017. Preoperative evaluation, consent, and holding area tasks were completed before entering the block room; the times to complete these tasks were not available for study. Upon block room entry, the electronic anesthetic record was started, a timeout conducted with patient participation, vital signs taken, and the spinal performed. The interval from entry until intrathecal injection was the spinal block time. Because fits of these times to probability distributions previously used for anesthesia times were poor (p < 0.001), percentiles of times to perform one or more spinal anesthetics were calculated using Monte-Carlo simulation (100,000 samples with replacement) from the empirical distributions. ResultsThe mean spinal block time was 8.8 minutes. The 90% upper prediction limit for one block was 14 minutes, with progressively decreasing times for each subsequent block for a 90% chance of finishing on time. For example, for three first-case regional or neuraxial blocks performed outside the operating room by one anesthesiologist, the first patient needs to arrive at least 38 minutes earlier than non-block patients to mitigate operating room start delays. ConclusionsThese minimum time estimates can help nursing leadership ensure that sufficient time will be available after patients are ready for anesthesia to avoid first-case delays when preoperative regional anesthesia is performed outside the operating room. Given that inadequate sample size and documentation issues likely exist universally for the various non-neuraxial preoperative nerve blocks, we recommend that hospitals use our estimates as a minimum starting point rather than try to calculate times using their own data. Then, as a systems-based metric to assess all steps in the process, track the percentages of days for which all blocks were completed in sufficient time to avoid a first-case delay for those patients. Adjustments to the arrival times would then be implemented, if needed, to meet hospital objectives for on-time starts.

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Increased Orthopedic Specialization Lowers Costs and Improves Outcomes in Total Joint Arthroplasty

Cited by 16 publications

References 28 publications

Is there a relationship between surgical volume and outcome for total elbow arthroplasty? A systematic review

Is there a relationship between surgical volume and outcome for total elbow arthroplasty? A systematic review

Comparison of Inpatient Charges between Primary and Revision Total Hip Arthroplasties: A Study of Trends within the New York's Statewide Planning and Research Cooperative System

Briefest Time to Perform a Series of Preoperative Nerve Blocks in Multiple Patients: A Simulation Study

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