Effects of provider patient volume and comorbidity on clinical and economic outcomes for total knee arthroplasty: a population-based study.

Our study examined how provider patient volume, postoperative infection rate, and perioperative complication affect length of stay, hospitalization charges, and adverse outcomes for patients undergoing total knee arthroplasty (TKA). The study sample included patients who had undergone total knee arthroplasty at all acute care hospitals in Taiwan between 2000 and 2003. Two economic indicators revealed linear associations with surgeon's patient volume, hospital's patient volume, and comorbidity score. Patients who developed postoperative infections remained hospitalized an average of 8.49 days longer than did patients with no infection. Postoperative infection was associated with surgeon experience. Our findings indicate that a surgeon's patient volume has a more significant effect than a hospital's patient volume on clinical outcomes. However, patient volumes for both surgeon and hospital are equally important in economic outcomes. Copyright 2010 Elsevier Inc. All rights reserved.