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Using the Stratum-Specific Likelihood Ratio Method to Derive Outcome-Based Hospital Volume Categories for Total Knee
Hassan M K Ghomrawi1,2,3,4, Lynn W Huang4, Annika N Hiredesai5,6
1Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Medical Care
|February 19, 2024
Summary
This study establishes evidence-based hospital volume categories for total knee replacement (TKR), showing lower volume hospitals have higher complication risks. These findings can improve patient care quality and decision-making.
Area of Science:
- Orthopedic Surgery
- Health Services Research
- Patient Outcomes
Background:
- Existing evidence linking hospital volume to total knee replacement (TKR) outcomes relies on arbitrary thresholds.
- There is a need for outcome-based volume benchmarks in TKR surgery.
Purpose of the Study:
- To establish evidence-based, outcome-driven hospital volume categories for primary total knee replacement (TKR).
- To utilize national data to define meaningful volume thresholds associated with post-operative complication rates.
Main Methods:
- Analysis of inpatient data from 2010-2015 (MedPAR Limited Data Set) for primary TKR patients.
- Definition of adverse events including in-hospital and 90-day readmission complications.
- Application of stratum-specific likelihood ratio (SSLR) and hierarchical logistic regression to identify volume categories and their association with complications.
Main Results:
- Four national volume categories for TKR were identified: low (1-31), medium (32-127), high (128-248), and very high (429+ cases/year).
- Lower hospital volume categories were significantly associated with increased odds of 90-day post-operative complications.
- Sensitivity analyses confirmed the robustness of these findings.
Conclusions:
- This research provides the first national, evidence-based volume categories for total knee replacement (TKR).
- Dissemination of these outcome-based thresholds can inform quality improvement initiatives for patients, providers, and payers.
