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Complications after hip arthroplasty and the association with hospital procedure volume
Laura M de Vries1, Miriam C J M Sturkenboom, Jan A N Verhaar
1Dutch Health Care Inspectorate, the Hague. lm.d.vries@igz.nl
Insights
Higher hip arthroplasty volume in Dutch hospitals correlated with fewer complications during admission, but not lower mortality. This suggests procedure volume impacts outcomes, though the effect may be diluted by widespread high-volume practices.
Area of Science:
- Orthopedic Surgery
- Health Services Research
Background:
- Higher procedure volume in hip arthroplasty may reduce complications.
- Investigating the link between procedure volume and serious negative outcomes is crucial for patient safety.
Purpose of the Study:
- To investigate the incidence of serious negative outcomes after total hip replacement.
- To determine the association between hospital procedure volume and complications/mortality.
Main Methods:
- Retrospective nationwide cohort study of 50,080 primary total hip replacements in Dutch hospitals (2002-2004).
- Assessed endpoints: mortality, in-hospital complications, and re-admission within 3 months.
- Risk factors analyzed: age, sex, admission duration, diagnosis, admission type, comorbidity, and hospital procedure volume.
Main Results:
- Age, sex, and comorbidity were associated with complications and mortality.
- Acute admission was a risk factor for mortality but not complications.
- No linear trend found between decreasing volume and increasing complications; no significant effect on mortality.
Conclusions:
- Hospitals with higher annual hip arthroplasty volume had fewer index admission complications.
- Higher volume hospitals did not demonstrate lower mortality rates compared to lower volume ones.
- Lack of a clear linear trend may stem from most Dutch hospitals performing a high number of procedures annually.
Background And Purpose:
It has been suggested that a higher procedure volume is associated with less complications after hip arthroplasty. In order to investigate the incidence of serious negative outcomes and a possible association with procedure volume, we performed a retrospective nationwide cohort study on total hip replacements in all Dutch hospitals.
Methods:
All total hip replacements (n = 50,080) that were identified as primary intervention in all general and university medical centers between January 1, 2002 and October 1, 2004 were included. Primary endpoints of follow-up were mortality and complications during admission, and re-admission within 3 months due to complications. Variables that were assessed as potential risk factor were age, sex, duration of (preoperative) admission, specific diagnosis, acute/non-planned admission, co-morbidity, and hospital procedure volume.
Results:
Age, sex, and comorbidity were associated with complications and mortality. Additionally, acute admission was a risk factor for mortality but not for complications. There was no linear trend indicating that decreasing volume led to an increasing number of complications, and no statistically sginificant effect for mortality was found.
Interpretation:
After adjustment for several risk factors, we found that the hospitals performing most hip procedures every year had fewer complications during index admission, but that they did not have a lower mortality than groups performing fewer procedures. The lack of a linear trend may be explained by the fact that almost all Dutch hospitals perform a high number of hip arthroplasties each year.
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