Patients who undergo hip and knee arthroplasty at hospitals with lower surgical volume are at a greater risk for blood clots and mortality, according to findings in Arthritis & Rheumatism, a peer-reviewed journal of the American College of Rheumatology. Patients also had a higher risk of venous thromboembolism following the procedure.
The complications following joint replacement surgery at low-volume sites may be reduced by modifying systems and procedures used before and after surgery, according to the research.
The study explores the relationship between hospital procedure volume and surgical outcomes following primary total hip or total knee replacements. “With the large number of elective arthroplasty in the U.S, it is important to understand the impact of peri- and post-operative medical complications on the success of joint replacement surgery,” said lead author Jasvinder Singh, MD, MPH, of the University of Alabama. “Possible cardiac complications, blood clots, or infections increase patient morbidity and mortality risk, which can lead to higher health care utilization and costs.”
Researchers used the Pennsylvania Health Care Cost Containment Council database to identify the number of patients who underwent total hip replacement (n=10,187) and total knee replacement (n=19,418) surgery in 2002 in the state. The mean age of patients in both groups was 69 years, and men comprised 43% of the total hip replacement cohort and 35% of the total knee replacement group. Hospital volume was categorized by less than 25 surgeries, 26-100, 101-200 (low-volume hospitals), and greater than 200 surgeries (high-volume hospitals) performed annually.
The findings show that patients who had primary total hip arthroplasty at low-volume hospitals were more likely to develop a pulmonary embolism (within 30 days of surgery) than those who had surgery at a high-volume hospital. One-year mortality was also higher for patients having total hip replacements at low-volume hospitals.
Researchers found that for total knee arthroplasty, patients age 65 and older had significantly higher odds for one-year mortality when surgeries were performed at low-volume hospitals compared to higher volume hospitals.
[Source: American College of Rheumatology]