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Provider Volume of Total Knee Arthroplasties and Patient Outcomes in the HCUP-Nationwide Inpatient Sample.

Publication ,  Journal Article
Hervey, SL; Purves, HR; Guller, U; Toth, AP; Vail, TP; Pietrobon, R
Published in: J Bone Joint Surg Am
September 2003

BACKGROUND: The relationship between volume and outcome of total knee arthroplasties has never been evaluated in a nationally representative sample, to our knowledge. We hypothesized that surgeons and hospitals with higher patient volumes would have better outcomes, as defined by lower mortality rates, shorter hospital stays, and lower postoperative complication rates. METHODS: The 1997 Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample, Release 6, provided discharge abstracts of patients undergoing total knee arthroplasty from a national stratified probability sample. Logistic and multiple regression models were used to estimate the adjusted association of surgeon or hospital volume with rates of in-hospital mortality, pulmonary thromboembolism, deep venous thrombosis in the lower extremity, and postoperative wound infection as well as length of hospital stay. Estimates were calculated for a target population of 277,550 patients. Models were adjusted for comorbidity, age, gender, race, household income, and procedure (primary or revision arthroplasty). RESULTS: The patients were mostly white (70.2%) and female (62.7%), with a mean age of 68.9 years. The overall in-hospital mortality rate for the target population was 0.2%, and the average length of stay was 4.6 days for the primary total knee arthroplasties and 4.9 days for the revision procedures. Surgeon volumes of at least fifteen procedures per year and hospital volumes of at least eighty-five per year were significantly and linearly associated with lower mortality rates (odds ratio = 0.56 [0.24 to 1.31] for surgeon volume of > or = 60). No other association demonstrated a significant and directionally consistent linear trend for improved outcomes. CONCLUSION: Patients treated by providers with lower caseload volumes had higher rates of mortality following total knee arthroplasty in 1997. Proposing volume standards could decrease patient mortality following this procedure.

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Published In

J Bone Joint Surg Am

DOI

ISSN

0021-9355

Publication Date

September 2003

Volume

85

Issue

9

Start / End Page

1775 / 1783

Location

United States

Related Subject Headings

  • Workload
  • United States
  • Treatment Outcome
  • Retrospective Studies
  • Reoperation
  • Regression Analysis
  • Practice Patterns, Physicians'
  • Postoperative Complications
  • Orthopedics
  • Odds Ratio
 

Citation

APA
Chicago
ICMJE
MLA
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Hervey, S. L., Purves, H. R., Guller, U., Toth, A. P., Vail, T. P., & Pietrobon, R. (2003). Provider Volume of Total Knee Arthroplasties and Patient Outcomes in the HCUP-Nationwide Inpatient Sample. J Bone Joint Surg Am, 85(9), 1775–1783. https://doi.org/10.2106/00004623-200309000-00017
Hervey, Sheleika L., Harriett R. Purves, Ulrich Guller, Alison P. Toth, Thomas P. Vail, and Ricardo Pietrobon. “Provider Volume of Total Knee Arthroplasties and Patient Outcomes in the HCUP-Nationwide Inpatient Sample.J Bone Joint Surg Am 85, no. 9 (September 2003): 1775–83. https://doi.org/10.2106/00004623-200309000-00017.
Hervey SL, Purves HR, Guller U, Toth AP, Vail TP, Pietrobon R. Provider Volume of Total Knee Arthroplasties and Patient Outcomes in the HCUP-Nationwide Inpatient Sample. J Bone Joint Surg Am. 2003 Sep;85(9):1775–83.
Hervey, Sheleika L., et al. “Provider Volume of Total Knee Arthroplasties and Patient Outcomes in the HCUP-Nationwide Inpatient Sample.J Bone Joint Surg Am, vol. 85, no. 9, Sept. 2003, pp. 1775–83. Pubmed, doi:10.2106/00004623-200309000-00017.
Hervey SL, Purves HR, Guller U, Toth AP, Vail TP, Pietrobon R. Provider Volume of Total Knee Arthroplasties and Patient Outcomes in the HCUP-Nationwide Inpatient Sample. J Bone Joint Surg Am. 2003 Sep;85(9):1775–1783.
Journal cover image

Published In

J Bone Joint Surg Am

DOI

ISSN

0021-9355

Publication Date

September 2003

Volume

85

Issue

9

Start / End Page

1775 / 1783

Location

United States

Related Subject Headings

  • Workload
  • United States
  • Treatment Outcome
  • Retrospective Studies
  • Reoperation
  • Regression Analysis
  • Practice Patterns, Physicians'
  • Postoperative Complications
  • Orthopedics
  • Odds Ratio