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Inconsistent Surgical Implant Documentation: A Case Study in Total Knee and Hip Arthroplasty
Logan D Cho1, Gregory W Hruby2, Alex H Illescas3
1Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Health Services Insights
|April 3, 2023
Summary
Hospital documentation for total knee and hip arthroplasty (TKA, THA) implants is often either excellent or poor. Teaching hospitals showed poorer documentation quality for these orthopedic procedures.
Area of Science:
- Health Services Research
- Orthopedic Surgery
- Health Informatics
Background:
- Value-based care models necessitate precise measurement of healthcare resource utilization.
- Accurate documentation of implant components is crucial for tracking resource use in orthopedic procedures like total knee arthroplasty (TKA) and total hip arthroplasty (THA).
Purpose of the Study:
- To evaluate hospital performance in documenting TKA and THA implant components.
- To investigate variations in documentation completeness across different hospital types.
- To compare TKA/THA documentation with that of endovascular stent procedures.
Main Methods:
- Retrospective analysis of the Premier discharge database (2006-2020).
- Categorization of TKA/THA cases into five documentation tiers (Platinum to Poor).
- Correlation and logistic regression analyses to assess documentation performance and hospital characteristics.
Main Results:
- Hospitals typically exhibited either highly complete (Platinum) or very incomplete (Poor) documentation for both TKA and THA implants.
- TKA and THA documentation performance were strongly correlated (r=0.70).
- Teaching hospitals demonstrated significantly lower satisfactory documentation rates for both TKA and THA compared to non-teaching hospitals.
Conclusions:
- Hospital implant documentation for TKA and THA is polarized, with performance being either proficient or deficient.
- Documentation quality for TKA/THA was inferior to that of endovascular stent procedures.
- Hospital teaching status, but not region, bed size, or urban/rural location, was associated with documentation completeness.
