Evidence-Based Hospital Procedural Volumes as Predictors of Outcomes After Revision Hip Arthroplasty

Schwartz, Andrew M.; Farley, Kevin X.; Nazzal, Ehab M.; Manz, Wesley J.; Bradbury, Thomas L.; Guild, George N.

doi:10.1016/j.arth.2020.05.008

Cited by 9 publications

(6 citation statements)

References 51 publications

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“…Dies gilt insbesondere für die primäre Hüft- und Knieendoprothetik 15 , 16 , 17 , 18 , 19 . Aber auch in der Revisionsendoprothetik lassen sich positive Effekte bei höheren Behandlungszahlen pro Zentrum nachweisen 20 21 22 23 . Wenngleich die Untersuchungen meist einen generellen Trend zeigen, ist die Ableitung konkreter Mindestmengen sowohl für einzelne Operateure als auch Kliniken aus bisherigen Studien kaum möglich.…”

Section: Internationale Entwicklungen Zur Zentren- Und Registerbildun...unclassified

EndoProthetikZentrum

Röth¹,

Weber²,

Pempe³

et al. 2022

Orthopädie und Unfallchirurgie up2date

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Section: Internationale Entwicklungen Zur Zentren- Und Registerbildun...unclassified

EndoProthetikZentrum

Röth¹,

Weber²,

Pempe³

et al. 2022

Orthopädie und Unfallchirurgie up2date

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“…In joint replacement surgery, increasing hospital case volume can reduce poor outcomes through generating peri-operative management pathways, multi-disciplinary team familiarity, and surgical experience. 22 Farley et al supported the role of high volume centers, reporting greater revision rates post rTSR in centres with less than 16 operations. 23 When compared to the top volume tier, which was statistically determined to be greater than 54 operations annually, the odds of revision increased by 1.88 (95% CI 1.44, 2.47).…”

Section: Discussionmentioning

confidence: 98%

“…Second, hospital and surgeon case volume may influence outcomes. In joint replacement surgery, increasing hospital case volume can reduce poor outcomes through generating peri‐operative management pathways, multi‐disciplinary team familiarity, and surgical experience 22 . Farley et al .…”

Section: Discussionmentioning

confidence: 99%

Does hospital setting influence shoulder replacement revision rate? A national comparison of outcomes between private and public settings

Paltoglou,

Gill,

Lorimer

et al. 2023

ANZ Journal of Surgery

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BackgroundAustralian healthcare relies on both private and public sectors to meet the demand for surgical care. Rapid growth of shoulder replacement surgery highlights a disparity in service provision, with two‐thirds occurring privately. This study aimed to assess the influence of hospital setting on shoulder replacement revision rate at a national level.MethodsAll primary shoulder replacements recorded by the Australian Orthopaedic Association National Joint Replacement Registry from April 2004 to December 2020 were included. Private and public settings were compared for stemmed total shoulder replacement (sTSR) for osteoarthritis (OA), reverse total shoulder replacement (rTSR) for OA/cuff arthropathy (CA), and rTSR for fracture. The primary outcome was cumulative percent revision (CPR), with Kaplan–Meier estimates of survivorship to determine differences between private and public hospitals, recorded as hazard ratios (HR). Secondary analyses investigated differences between hospital settings, targeting hospital outliers for revision and prosthesis selection.ResultsPrimary sTSR (OA) demonstrated a higher revision rate in private hospitals compared to public hospitals (HR = 1.27; P = 0.001), as did rTSR (OA/CA) after 3 months (HR = 1.33; P = 0.003). However, no significant difference was observed for primary rTSR (fracture) (HR = 1.10; P = 0.484). Restricting rTSR (OA/CA) to the best performing prosthesis combinations eliminated the difference between private and public outcomes (HR 1.10; P = 0.415). No other secondary analysis altered the primary result.ConclusionsDifferences exist between private and public hospitals for revision rate following primary shoulder replacement. Prosthesis selection accounts for some of the variation. Further analysis into patient specific characteristics is necessary to better understand these disparities.

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“…Understanding the epidemiology of revision arthroplasty may help elucidate the relationships between complexity of revision and reimbursement in a healthcare system that continues to shift towards value-based health care. 24 The most recent American Joint Replacement Registry (AJRR) analysis by the American Academy of Orthopaedic Surgeons determined the mean number of revision hip arthroplasty procedures performed annually by surgeons in the registry was 3.4 (1 to 4). 25 This revision burden may be exponentially greater for surgeons at large urban tertiary referral centres than is reported in the AJRR.…”

Section: Discussionmentioning

confidence: 99%

An epidemiological analysis of revision aetiologies in total hip arthroplasty at a single high-volume centre

et al. 2021

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Aims Advances in surgical technique and implant design may influence the incidence and mechanism of failure resulting in revision total hip arthroplasty (rTHA). The purpose of the current study was to characterize aetiologies requiring rTHA, and to determine whether temporal changes existed in these aetiologies over a ten-year period. Methods All rTHAs performed at a single institution from 2009 to 2019 were identified. Demographic information and mode of implant failure was obtained for all patients. Data for rTHA were stratified into two time periods to assess for temporal changes: 2009 to 2013, and 2014 to 2019. Operative reports, radiological imaging, and current procedural terminology (CPT) codes were cross-checked to ensure the accurate classification of revision aetiology for each patient. Results In all, 2,924 patients with a mean age of 64.6 years (17 to 96) were identified. There were 1,563 (53.5%) female patients, and the majority of patients were Caucasian (n = 2,362, 80.8%). The three most frequent rTHA aetiologies were infection (27.2%), aseptic loosening (25.2%), and wear (15.2%). The frequency of rTHA for adverse local tissue reaction (ALTR) was significantly greater from 2014 to 2019 (4.7% vs 10.0%; p < 0.001), while the frequency of aseptic loosening was significantly greater from 2009 to 2013 (28.6% vs 21.9%; p < 0.001). Conclusion Periprosthetic joint infection was the most common cause for rTHA in the current cohort of patients. Complications associated with ALTR necessitating rTHA was more frequent between 2014 to 2019, while aseptic loosening necessitating rTHA was significantly more frequent between 2009 to 2013. Optimizing protocols for prevention and management of infection and ALTR after THA may help to avoid additional financial burden to institutions and healthcare systems. Cite this article: Bone Joint Open 2020;2(1):16–21.

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Evidence-Based Hospital Procedural Volumes as Predictors of Outcomes After Revision Hip Arthroplasty

Cited by 9 publications

References 51 publications

EndoProthetikZentrum

EndoProthetikZentrum

Does hospital setting influence shoulder replacement revision rate? A national comparison of outcomes between private and public settings

An epidemiological analysis of revision aetiologies in total hip arthroplasty at a single high-volume centre

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