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How safe is primary knee replacement surgery? Perioperative complication rates in Northern Illinois, 1993-1999
Joe Feinglass1, Hagay Amir, Patricia Taylor
1Northwestern University Medical School and Northwestern University, Chicago, IL 60611, USA. j-feinglass@northwestern.edu
Objective:
To describe inpatient complications for primary total knee replacement (TKR) in a period of rapidly growing orthopedic surgery capacity, declining length of stay, and more frequent discharge to rehabilitation facilities.
Methods:
Complication incidence according to published coding algorithms was estimated for 35,531 primary TKR admissions of northern Illinois residents to 65 Illinois hospitals. Complication odds were estimated as a function of patients' clinical and sociodemographic status, hospital volume, residency training, TKR length of stay, International Classification of Diseases, Ninth Revision (ICD-9) coding intensity, and discharges to skilled nursing or rehabilitation facilities.
Results:
Primary TKR admissions increased 36% between 1993 and 1999, length of stay declined 43%, average ICD-9 code use increased 31%, and rehabilitation discharges increased 68%. Major complication rates declined 44% (12.4% to 6.9%; P < 0.0001) over this period, reflecting a 50% reduction in the adjusted odds of complication between 1993 and 1999. There was no association of procedure volume and outcome.
Conclusion:
It is likely that the reduction in complications reflects true safety improvements as well as reduced length of stay.