Journal article
Evidence-Based Hospital Procedural Volumes as Predictors of Outcomes After Revision Hip Arthroplasty
The Journal of arthroplasty, Vol.35(10), pp.2952-2959
10/2020
DOI: 10.1016/j.arth.2020.05.008
PMID: 32507450
Abstract
The aim of this study is to define the evidence-based institutional volume-outcome relationship in revision hip arthroplasty. We hypothesized that high-volume centers would be associated with superior outcomes, and that stratum-specific likelihood ratio (SSLR) analysis would delineate concrete volume thresholds for optimizing outcomes.
The Nationwide Readmission Database was queried from 2011 to 2016 for patients undergoing revision hip arthroplasty. SSLR analysis was used to determine hospital volume cutoffs specific for outcomes of interest. Volume categories were confirmed with multivariate regression.
SSLR analysis produced distinct hospital volume cutoffs for all outcomes. Each subsequent volume threshold diminished patients' risk for adverse outcomes. Tertiles were identified for 90-day infection (≤6, 7-51, ≥52 cases per year). Quartiles were found for 90-day readmission (≤5, 6-15, 16-79, ≥80), 90-day prosthesis-related complication (≤5, 6-16, 17-65, ≥66), 90-day dislocation (≤5, 6-19, 20-79, ≥80), and non-home discharge (≤5, 6-15, 16-40, and ≥41). Quintiles were generated for extended length of stay >2 days (≤2, 3-10, 11-20, 21-30, ≥31). Heptiles were produced for medical complications within 90 days (≤2, 3-8, 9-16, 17-51, 52-89, ≥90).
This is the first known study to define evidence-based thresholds for the impact of hospital volume on revision joint arthroplasty. This supports the notion that institutional volume functions as a surrogate for protocolized interdisciplinary coordination of care and surgical experience, and that high-volume centers offer enhanced outcomes for complex cases. Additional studies should investigate the potential role for incentivization of such institutions, as they offer optimal outcomes for revision hip arthroplasty.
Details
- Title: Subtitle
- Evidence-Based Hospital Procedural Volumes as Predictors of Outcomes After Revision Hip Arthroplasty
- Creators
- Andrew M Schwartz - Emory University Orthopaedics and Spine HospitalKevin X Farley - Emory University Orthopaedics and Spine HospitalEhab M Nazzal - Emory University Orthopaedics and Spine HospitalWesley J Manz - Emory University Orthopaedics and Spine HospitalThomas L. Bradbury Jr - Department of Orthopedic Surgery, Emory Orthopaedics & Spine Centre, Atlanta, GAGeorge N. Guild III - Department of Orthopedic Surgery, Emory Orthopaedics & Spine Centre, Atlanta, GA
- Resource Type
- Journal article
- Publication Details
- The Journal of arthroplasty, Vol.35(10), pp.2952-2959
- DOI
- 10.1016/j.arth.2020.05.008
- PMID
- 32507450
- ISSN
- 0883-5403
- eISSN
- 1532-8406
- Language
- English
- Date published
- 10/2020
- Academic Unit
- Orthopedics and Rehabilitation
- Record Identifier
- 9984304693602771
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