Surgeon and Facility Volume are Associated With Postoperative Complications After Total Knee Arthroplasty

Arthroplasty Today

Kang Woo Kim, BA¹  Joseph A. Gil, MD²  Aristides I. Cruz, Jr., MD, MBA²  Eric M. Cohen, MD²  Jacob M. Modest, MD³  Peter G. Brodeur, MA³ 

[1] Corresponding author. Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, USA. Tel.: [phone].;Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA;Warren Alpert Medical School of Brown University, Providence, RI, USA;

关键词: Knee arthroplasty;    Complications;    Revision;    Volume;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: Surgeon and hospital volumes may affect outcomes of various orthopedic procedures. The purpose of this study is to characterize the volume dependence of both facilities and surgeons on morbidity and mortality after total knee arthroplasty. Methods: Adults who underwent total knee arthroplasty for osteoarthritis from 2011 to 2015 were identified using International Classification of Diseases-9 Clinical Modification diagnostic and procedural codes in the New York Statewide Planning and Research Cooperative System database. Readmission, in-hospital mortality, and other adverse events were compared across surgeon and facility volumes using multivariable Cox proportional hazards regression, while controlling for patient demographic and clinical factors. Surgeon and facility volumes were compared between the lowest and highest 20%. Results: Of 113,784 identified patients, 71,827 were treated at a high- or low-volume facility or by low- or high-volume surgeon. Low-volume facilities had higher 1-month, 3-month, and 12-month rates of readmission, urinary tract infection, cardiorespiratory arrest, surgical site infection, and wound complications; higher 3- and 12-month rates of pneumonia, cellulitis, and in-facility mortality; and higher 12-month rates of acute renal failure and revision. Low-volume surgeons had higher 1-, 3-, and 12-month rates of readmission, urinary tract infection, acute renal failure, pneumonia, surgical site infection, deep vein thrombosis, pulmonary embolism, cellulitis, and wound complications; higher 3- and 12-month rates of cardiorespiratory arrest; and higher 12-month rate of in-facility mortality. Conclusions: These results suggest volume shifting toward higher volume facilities and/or surgeons could improve patient outcomes and have potential cost savings. Furthermore, these results can inform healthcare policy, for example, designating institutions as centers of excellence.

【 授权许可】

Unknown