ICJR ABSTRACTS: Hospital Procedural Volume and Outcomes in Revision Hip Arthroplasty
At the 7th Annual ICJR South Hip & Knee Course, 6 awards were given to orthopaedic residents and fellows who submitted the best research abstracts in hip and knee replacement. The abstract Hospital Procedural Volume and Outcomes in Revision Hip Arthroplasty received the Best Design Award: Hip Arthroplasty and was presented at the meeting by Andrew Schwartz, MD.
Andrew M. Schwartz, MD; Kevin X. Farley, BS; George N. Guild, MD; and Thomas L. Bradbury, MD
The effect of annual hospital procedural volume on outcomes following revision hip arthroplasty (rTHA) is not currently known. The goal of the current study was to elucidate an evidence-based definition of the institutional volume-outcome relationship in rTHA. We hypothesized that more experienced joint reconstruction centers would be associated with superior outcomes, where high volume would be concretely defined through stratum-specific likelihood ratios (SSLR).
The Nationwide Readmission Database was queried from 2011-2016 for patients undergoing rTHA, excluding prosthetic joint infection and peri-prosthetic fracture. SSLR established hospital volume cutoffs for each outcome and was confirmed with multivariate regression (controlling for demographics/comorbidities). Pairwise comparisons ensured that each stratum was statistically discrete.
Distinct hospital volume cut-offs were successfully generated, and subsequent threshold diminished adverse outcomes. Hospital volume tertiles were identified for 90-day infection (≤6, 7-51, ≥51 patients per year). Institutional quartiles were found for 90-day readmission (≤5, 6-19, 20-79, ≥80), 90-day non-infectious hip-specific complications (≤5, 6-16, 16-59, ≥60), and non-home discharge (≤5, 6-15, 16-40, ≥41). Quintiles were generated for extended length of stay >3 days (≤2, 2-10, 11-20, 21-30, 31-43, ≥44). Heptiles were produced for any medical complication occurring within 90-days (≤5, 6-15, 16-24, 25-39, 40-79, ≥80).
This is the first known study to define evidence-based thresholds for the effect of hospital volume on rTHA, supporting institutional volume as a surrogate for protocolized interdisciplinary coordination of care and surgical experience. High-volume centers offer value-driven enhanced surgical and medical outcomes for rTHA; such institutions should be incentivized by payers.
Click the image above to watch Dr. Schwartz’s presentation of this Best Design Award-winning abstract.
Andrew M. Schwartz, MD; Kevin X. Farley, BS; George N. Guild, MD; and Thomas L. Bradbury, MD, are from the Department of Orthopaedic Surgery at Emory University School of Medicine, Atlanta, Georgia.