Peter Cram1, Bruce E Landon2, John Matelski3, Vicki Ling4, Therese A Stukel5, J Michael Paterson4, Rajiv Gandhi6, Gillian A Hawker7, Bheeshma Ravi7. 1. University of Toronto, Sinai Health System and University Health Network, and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 2. Harvard Medical School, Boston, Massachusetts. 3. Sinai Health System and University Health Network, Toronto, Ontario, Canada. 4. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 5. Institute for Clinical Evaluative Sciences and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada, and Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. 6. University of Toronto, Toronto, Ontario, Canada. 7. University of Toronto and Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Abstract
OBJECTIVE: Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are common and effective surgical procedures. This study sought to compare utilization and short-term outcomes of primary TKA and THA in adjacent regions of Canada and the United States. METHODS: The study was designed as a retrospective cohort study of patients who underwent primary TKA or THA, comparing administrative data from New York and Ontario in 2012-2013. Demographic features of the TKA and THA patients, per capita utilization rates, and short-term outcomes were compared between the jurisdictions. RESULTS: A higher percentage of New York hospitals performed TKA compared to Ontario hospitals (75.7% versus 42.1%; P < 0.001), and the mean annual procedural volume for TKAs was lower in New York hospitals (mean 179 versus 327 in Ontario hospitals; P < 0.001). After direct standardization, utilization was significantly lower in New York compared to Ontario, both for TKA (16.1 TKAs versus 21.4 TKAs per 10,000 population per year; P < 0.001) and for THA (10.5 THAs versus 11.5 THAs per 10,000 population per year; P < 0.001). For those who underwent TKA, the length of stay in Ontario hospitals was significantly longer (mean 3.7 days versus 3.4 days in New York hospitals; P < 0.001). A smaller percentage of New York patients were discharged directly home (46.2% versus 90.9% of Ontario patients; P < 0.001), but 30-day and 90-day readmission rates were higher in New York compared to Ontario (30-day rates, 4.6% versus 3.9% [P < 0.001]; 90-day rates, 8.4% versus 6.7% [P < 0.001]). For the THA cohorts, the results with regard to length of stay, discharge disposition, and readmission rates were similar to those for TKA. CONCLUSION: Ontario has higher utilization of total joint arthroplasty than New York but has a smaller percentage of hospitals performing these procedures. Patients are more likely to be discharged home and less likely to be readmitted in Ontario. Our results suggest areas where each jurisdiction could improve.
OBJECTIVE: Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are common and effective surgical procedures. This study sought to compare utilization and short-term outcomes of primary TKA and THA in adjacent regions of Canada and the United States. METHODS: The study was designed as a retrospective cohort study of patients who underwent primary TKA or THA, comparing administrative data from New York and Ontario in 2012-2013. Demographic features of the TKA and THA patients, per capita utilization rates, and short-term outcomes were compared between the jurisdictions. RESULTS: A higher percentage of New York hospitals performed TKA compared to Ontario hospitals (75.7% versus 42.1%; P < 0.001), and the mean annual procedural volume for TKAs was lower in New York hospitals (mean 179 versus 327 in Ontario hospitals; P < 0.001). After direct standardization, utilization was significantly lower in New York compared to Ontario, both for TKA (16.1 TKAs versus 21.4 TKAs per 10,000 population per year; P < 0.001) and for THA (10.5 THAs versus 11.5 THAs per 10,000 population per year; P < 0.001). For those who underwent TKA, the length of stay in Ontario hospitals was significantly longer (mean 3.7 days versus 3.4 days in New York hospitals; P < 0.001). A smaller percentage of New York patients were discharged directly home (46.2% versus 90.9% of Ontario patients; P < 0.001), but 30-day and 90-day readmission rates were higher in New York compared to Ontario (30-day rates, 4.6% versus 3.9% [P < 0.001]; 90-day rates, 8.4% versus 6.7% [P < 0.001]). For the THA cohorts, the results with regard to length of stay, discharge disposition, and readmission rates were similar to those for TKA. CONCLUSION: Ontario has higher utilization of total joint arthroplasty than New York but has a smaller percentage of hospitals performing these procedures. Patients are more likely to be discharged home and less likely to be readmitted in Ontario. Our results suggest areas where each jurisdiction could improve.
Authors: José M Quintana; Inmaculada Arostegui; Antonio Escobar; Jesus Azkarate; J Ignacio Goenaga; Iratxe Lafuente Journal: Arch Intern Med Date: 2008-07-28
Authors: Hassan M K Ghomrawi; Michael Alexiades; Helene Pavlov; Denis Nam; Yoshimi Endo; Lisa A Mandl; Alvin I Mushlin Journal: Arthritis Care Res (Hoboken) Date: 2014-11 Impact factor: 4.794
Authors: Pamela L Hudak; Pamela Grassau; Richard H Glazier; Gillian Hawker; Hans Kreder; Peter Coyte; Nizar Mahomed; James G Wright Journal: Med Decis Making Date: 2008-06-16 Impact factor: 2.583
Authors: Bheeshma Ravi; Richard Jenkinson; Peter C Austin; Ruth Croxford; David Wasserstein; Benjamin Escott; J Michael Paterson; Hans Kreder; Gillian A Hawker Journal: BMJ Date: 2014-05-23
Authors: Peter Cram; Saket Girotra; John Matelski; Maria Koh; Bruce E Landon; Lu Han; Douglas S Lee; Dennis T Ko Journal: Circ Cardiovasc Qual Outcomes Date: 2020-01-20
Authors: Peter Cram; Mark E Cohen; Clifford Ko; Bruce E Landon; Bruce Hall; Timothy D Jackson Journal: World J Surg Date: 2022-01-31 Impact factor: 3.352
Authors: Peter Cram; Bruce E Landon; John Matelski; Vicki Ling; Anthony V Perruccio; J Michael Paterson; Y Raja Rampersaud Journal: Spine (Phila Pa 1976) Date: 2019-10-01 Impact factor: 3.241