Hospital Network Centralization of Primary Total Joint Arthroplasty Is Associated With Reduced Early Complication...

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Health Policy

Background:

• Hospital networks centralize primary total joint arthroplasty (TJA) to increase surgical volumes and reduce adverse events.
• The impact of hospital network centralization on primary TJA outcomes remains unclear.

Purpose of the Study:

• To investigate the association between hospital network centralization and primary TJA outcomes.
• Specifically, to examine effects on 90-day complication rates, 90-day readmission rates, and 1-year revision rates.

Main Methods:

• Retrospective analysis of Medicare Part A data for primary TJA patients (2016-2017).
• Defined hospital network centralization by the percentage of total network cases at the highest-volume hospital, categorized into quartiles.
• Used multivariable regressions to assess associations, controlling for patient and hospital factors.

Main Results:

• Increased centralization in hospital networks was linked to lower 90-day complication rates (OR=0.85; 95% CI: 0.75, 0.95).
• No significant association was found between centralization and 90-day readmission or 1-year revision rates.
• Patient and individual hospital factors showed a stronger association with outcomes than network centralization or volume.

Conclusions:

• Centralizing primary TJA within hospital networks may reduce early postoperative complications.
• Network structural changes could benefit patient outcomes, but non-modifiable risk factors require careful consideration in outcome assessments.
• Further research into risk adjustment for patient and hospital factors is recommended.