Elke Jeschke1, Thorsten Gehrke2, Christian Günster1, Karl-Dieter Heller3, Hanna Leicht1, Jürgen Malzahn4, Fritz Uwe Niethard5, Peter Schräder6, Josef Zacher7, Andreas M Halder8. 1. Research Institute of the Local Health Care Funds, Berlin, Germany. 2. Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany. 3. Department of Orthopaedic Surgery, Herzogin Elisabeth Hospital, Braunschweig, Germany. 4. Federal Association of the Local Health Care Funds, Berlin, Germany. 5. German Society of Orthopedics and Orthopedic Surgery, Berlin, Germany. 6. Department of Orthopaedic Surgery, Kreisklinik Jugenheim, Jugenheim, Germany. 7. Department of Orthopaedic Surgery, Helios Kliniken GmbH, Berlin, Germany. 8. Department of Orthopaedic Surgery, Sana Kliniken Sommerfeld, Sommerfeld, Germany.
Abstract
BACKGROUND: With the number of primary total hip arthroplasty (THA), the amount of revision THA (R-THA) increases. R-THA is a complex procedure requiring special instruments, implants, and surgical skills. Therefore it is likely that hospitals performing a higher number of R-THAs have more experience with this type of surgery and therefore fewer complications. The purpose of this study was to evaluate the relationship between hospital volume and risk of postoperative complications following R-THA. METHODS: Using nationwide healthcare insurance data for inpatient hospital treatment, 17,773 aseptic R-THAs in 16,376 patients treated between January 2014 and December 2016 were included. Outcomes were 90-day mortality, 1-year revision procedures, and in-house adverse events. The effect of hospital volume on outcome was analyzed by means of multivariate logistic regression. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: Hospital volume had a significant effect on 90-day mortality (≤12 cases per year: OR 2.13, CI 1.53-2.96; 13-24: OR 1.79, CI 1.29-2.50; 25-52: OR 1.53, CI 1.11-2.10; ≥53: reference) and 1-year revision procedures (≤12: OR 1.26, CI 1.09-1.47; 13-24: OR 1.18, CI 1.02-1.37; 25-52: OR 1.03, CI 0.90-1.19; ≥53: reference). There was no significant effect on risk-adjusted major in-house adverse events. CONCLUSION: We found evidence of higher risk for revision surgery and mortality in hospitals with fewer than 25 and 53 R-THA per year, respectively. To improve patient care, complex elective procedures like R-THA which require experience and a specific logistic background should be performed in specialized centers.
BACKGROUND: With the number of primary total hip arthroplasty (THA), the amount of revision THA (R-THA) increases. R-THA is a complex procedure requiring special instruments, implants, and surgical skills. Therefore it is likely that hospitals performing a higher number of R-THAs have more experience with this type of surgery and therefore fewer complications. The purpose of this study was to evaluate the relationship between hospital volume and risk of postoperative complications following R-THA. METHODS: Using nationwide healthcare insurance data for inpatient hospital treatment, 17,773 aseptic R-THAs in 16,376 patients treated between January 2014 and December 2016 were included. Outcomes were 90-day mortality, 1-year revision procedures, and in-house adverse events. The effect of hospital volume on outcome was analyzed by means of multivariate logistic regression. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: Hospital volume had a significant effect on 90-day mortality (≤12 cases per year: OR 2.13, CI 1.53-2.96; 13-24: OR 1.79, CI 1.29-2.50; 25-52: OR 1.53, CI 1.11-2.10; ≥53: reference) and 1-year revision procedures (≤12: OR 1.26, CI 1.09-1.47; 13-24: OR 1.18, CI 1.02-1.37; 25-52: OR 1.03, CI 0.90-1.19; ≥53: reference). There was no significant effect on risk-adjusted major in-house adverse events. CONCLUSION: We found evidence of higher risk for revision surgery and mortality in hospitals with fewer than 25 and 53 R-THA per year, respectively. To improve patient care, complex elective procedures like R-THA which require experience and a specific logistic background should be performed in specialized centers.
Authors: Gabriel Ramirez; Thomas G Myers; Caroline P Thirukumaran; Benjamin F Ricciardi Journal: Clin Orthop Relat Res Date: 2021-12-21 Impact factor: 4.755
Authors: Carolin Fleischmann-Struzek; Norman Rose; Antje Freytag; Melissa Spoden; Hallie C Prescott; Anna Schettler; Lisa Wedekind; Bianka Ditscheid; Josephine Storch; Sebastian Born; Peter Schlattmann; Christian Günster; Konrad Reinhart; Christiane S Hartog Journal: JAMA Netw Open Date: 2021-11-01