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Evidence-Based Hospital Procedural Volumes as Predictors of Outcomes After Revision Hip Arthroplasty.

Publication ,  Journal Article
Schwartz, AM; Farley, KX; Nazzal, EM; Manz, WJ; Bradbury, TL; Guild, GN
Published in: J Arthroplasty
October 2020

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

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Published In

J Arthroplasty

DOI

EISSN

1532-8406

Publication Date

October 2020

Volume

35

Issue

10

Start / End Page

2952 / 2959

Location

United States

Related Subject Headings

  • Risk Factors
  • Reoperation
  • Postoperative Complications
  • Orthopedics
  • Length of Stay
  • Humans
  • Hospitals, High-Volume
  • Databases, Factual
  • Arthroplasty, Replacement, Hip
  • 4003 Biomedical engineering
 

Citation

APA
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ICMJE
MLA
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Schwartz, A. M., Farley, K. X., Nazzal, E. M., Manz, W. J., Bradbury, T. L., & Guild, G. N. (2020). Evidence-Based Hospital Procedural Volumes as Predictors of Outcomes After Revision Hip Arthroplasty. J Arthroplasty, 35(10), 2952–2959. https://doi.org/10.1016/j.arth.2020.05.008
Schwartz, Andrew M., Kevin X. Farley, Ehab M. Nazzal, Wesley J. Manz, Thomas L. Bradbury, and George N. Guild. “Evidence-Based Hospital Procedural Volumes as Predictors of Outcomes After Revision Hip Arthroplasty.J Arthroplasty 35, no. 10 (October 2020): 2952–59. https://doi.org/10.1016/j.arth.2020.05.008.
Schwartz AM, Farley KX, Nazzal EM, Manz WJ, Bradbury TL, Guild GN. Evidence-Based Hospital Procedural Volumes as Predictors of Outcomes After Revision Hip Arthroplasty. J Arthroplasty. 2020 Oct;35(10):2952–9.
Schwartz, Andrew M., et al. “Evidence-Based Hospital Procedural Volumes as Predictors of Outcomes After Revision Hip Arthroplasty.J Arthroplasty, vol. 35, no. 10, Oct. 2020, pp. 2952–59. Pubmed, doi:10.1016/j.arth.2020.05.008.
Schwartz AM, Farley KX, Nazzal EM, Manz WJ, Bradbury TL, Guild GN. Evidence-Based Hospital Procedural Volumes as Predictors of Outcomes After Revision Hip Arthroplasty. J Arthroplasty. 2020 Oct;35(10):2952–2959.
Journal cover image

Published In

J Arthroplasty

DOI

EISSN

1532-8406

Publication Date

October 2020

Volume

35

Issue

10

Start / End Page

2952 / 2959

Location

United States

Related Subject Headings

  • Risk Factors
  • Reoperation
  • Postoperative Complications
  • Orthopedics
  • Length of Stay
  • Humans
  • Hospitals, High-Volume
  • Databases, Factual
  • Arthroplasty, Replacement, Hip
  • 4003 Biomedical engineering