Hospital-Wide Safety Performance Affects Complication Rates After Primary Total Hip and Knee Arthroplasty.

Area of Science:

• Orthopedic Surgery
• Healthcare Quality Improvement
• Patient Safety

Background:

• Arthroplasty (THA/TKA) outcomes depend on surgical technique and hospital systems.
• The link between hospital-wide patient safety and arthroplasty complications is not fully understood.

Purpose of the Study:

• To investigate the association between hospital-wide patient safety performance and complication rates in total hip arthroplasty and total knee arthroplasty.

Main Methods:

• Retrospective analysis of Medicare data (2021-2024) for 1551 hospitals.
• Examined risk-adjusted arthroplasty complication rates against the Patient Safety Indicator composite (PSI-90).
• Used weighted and unweighted linear regression to assess the association.

Main Results:

• Higher PSI-90 scores (worse safety) were linked to increased THA/TKA complication rates.
• Each unit increase in PSI-90 correlated with a 0.47 percentage-point rise in complications (P < .001).
• Findings were consistent across weighted and unweighted analyses.

Conclusions:

• Worse hospital-wide safety performance is associated with higher complication rates after THA/TKA.
• Arthroplasty outcomes are influenced by both procedure-specific factors and overall institutional safety systems.