The effect of hospital volume on length of stay, re-admissions, and complications of total hip arthroplasty

Abstract

Background and purpose Hospital volume has been suggested to be one of the best indicators of adverse orthopedic events in patients undergoing THR surgery. We therefore evaluated the effect of hospital volume on the length of stay, re-admissions, and complications of THR at the population level in Finland.Methods 30,266 THRs performed for primary osteoarthritis were identified from the Hospital Discharge Register. Hospitals were classified into 4 groups according to the number of THRs performed on an annual basis over the whole study period: 1–50 (group 1), 51–150 (group 2), 151–300 (group 3), and > 300 (group 4).Results In 2005, the length of the period of surgical treatment was 5.5 days in group 4 and 6.8 days in group 1 (the reference group). During the whole study period (1998–2005), the length of surgical treatment period was shorter in group 4 than in group 1 (p < 0.001). The odds ratio for dislocations (0.7, 95% CI: 0.6–0.9) was lower in group 3 than in group 1.Interpretation Hip replacements performed in high-volume hospitals reduce costs by shortening the length of stay, and they may reduce the dislocation rate.

Does surgical volume affect outcome after primary and revision knee arthroplasty? A systematic review of the literature

“…Following review nine of these papers were discarded for the following reasons: three were duplicates [3,8,13], two were editorials, one looked at the effect of physician owned hospitals on general competing hospitals, one looked at rural hospitals, one was a letter to the editor and one paper focused on Medicaid status. This left 21 papers of which nine were related to the knee [16][17][18][19][20][21][22][23][24], often as a more general assessment of the effect of volume on lower limb arthroplasty, and 12 looking at other aspects of orthopaedic practice [25][26][27][28][29][30][31][32][33][34][35][36]. An additional two papers [37,38] were also identified through a review of the bibliographies of identified papers.…”

“…They calculated that if, though a greater use of higher volume surgeons, the average length of stay could be reduced to 5 days it would result in a reduction of 28,000 hospital days annually across Denmark [22]. Significantly higher lengths of stay in low volume units (b10, b50 cases per year, respectively) were seen in the studies of Lavernia [33] and Mäkelä et al [28]. This finding is supported by the work of Kreder et al [27] and Bozic et al [36] who demonstrated a shorter length of stay for patients operated on by more experienced surgeons with no alteration in outcome.…”

“…Based on the literature presented one would assume that high volume surgeons, who are associated with decreased mortality, length of stay and complication rates as well as improved patient outcomes, should consistently achieve excellent results despite hospital volume [6,8,13,[16][17][18][20][21][22][26][27][28][29][30][31][35][36][37][38]. Harmon et al [61], in their work looking at outcomes after colorectal resection, however, found that when medium volume surgeons operated in medium or high volume centres they could still achieve results as good as high volume surgeons.…”

Impact of surgical experience on outcomes in total joint arthroplasties

“…Given the wide range of procedures, patient outcomes and patient samples studied, the variability and inconsistency of results amongst the current literature may in part be as a result of differences in study design. A recent systematic literature review demonstrated that in regards to lower limb arthroplasties, the association between primary surgeon experience and clinical outcomes remains contentious …”

“…A recent systematic literature review demonstrated that in regards to lower limb arthroplasties, the association between primary surgeon experience and clinical outcomes remains contentious. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] The ageing population has facilitated the need for an increase in the number of joint arthroplasty procedures. Total hip and knee arthroplasties are both common elective procedures that a capable trainee surgeon should be able to perform.…”