Hospital volume–outcome relationship in total knee arthroplasty: a systematic review and dose–response meta-analysis

Kugler, Charlotte Mareike; Goossen, Käthe; Rombey, Tanja; Santis, Karina Karolina De; Mathes, Tim; Breuing, Jessica; Heß, Simone; Burchard, René; Pieper, Dawid

doi:10.1007/s00167-021-06692-8

Cited by 15 publications

(10 citation statements)

References 114 publications

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“…A ceiling effect was observed in our cohort, and it was in accordance with the strong ceiling effect described by the original authors. Nevertheless, in the short term (3-6 months) following TKA and THA surgeries, improvements tend to be extremely positive [33,34], especially when performed in high-volume specialized centers such as the one where this study was conducted [35], and therefore, such an effect on satisfaction was expected.…”

Section: Discussionmentioning

confidence: 97%

Italian Translation, Adaptation, and Validation of the Novel Satisfaction Measure Assessment after Primary Total Joint Arthroplasty: The Goodman Score Questionnaire

et al. 2022

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Patient satisfaction after total joint arthroplasties (TJA) represents a key element for the evaluation of surgery success in relation to subjects’ needs and expectations. The assessment tools are applied inconsistently throughout the literature, and thus, it is difficult to compare results among different studies. Goodman et al. proposed a standardized questionnaire with strong psychometric properties for the assessment of satisfaction. The present study aims to translate, adapt, and validate the Goodman questionnaire for the Italian population. After translation and back translation, the questionnaire was administrated to 50 patients. Internal consistency, test–retest reliability, floor and ceiling effects, and construct validity were evaluated (correlation with KOOS/HOOS, SF-12 PCS/MCS, EQ-5D). Responsiveness was evaluated with respect to SF-12 PCS improvements. The Italian version of the Goodman score questionnaire demonstrated psychometric properties similar to those of the original version. The translated questionnaire showed good internal consistency (Cronbach’s alpha = 0.836) and test–retest reliability (ICC: 0.507). Moderate/strong correlations were observed between the Italian version of the Goodman score and other scores. The score significantly discriminated patients who improved from those who did not improve in SF-12 PCS after treatment. This study provides an adapted and validated Italian version of the Goodman score questionnaire, with psychometric properties similar to those of its original counterpart.

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Section: Discussionmentioning

confidence: 97%

Italian Translation, Adaptation, and Validation of the Novel Satisfaction Measure Assessment after Primary Total Joint Arthroplasty: The Goodman Score Questionnaire

et al. 2022

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Section: Discussionmentioning

confidence: 99%

“…A recent review of Kugler et al investigating the association of hospital volume-outcome in TKR, proposed a centralization of TKR to high volume hospitals, so a between hospital referral could be another option to consider. 21 The finding that the availability of a frequently used PKR seems more important in hospitals with a low KA volume should create some awareness. In frequently used hospitals patients are more likely to be offered a PKR as a treatment option compared to low volume hospitals.…”

Section: Discussionmentioning

confidence: 99%

Nationwide partial knee replacement uptake is influenced by volume and supplier––A Dutch arthroplasty register study

Oost

Koenraadt

Hoorntje

et al. 2022

J Orthop Surg (Hong Kong)

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Background Despite the established advantages of partial knee replacements (PKR), their usage remains limited. We investigated the effect of hospital knee arthroplasty (KA) volume and the availability of a frequently used PKR by the total KA supplier on the use of PKRs in a hospital. Methods A total of 190,204 total knee replacements (TKR) and 18,134 PKRs were identified in the Dutch Arthroplasty Register (LROI) from 2007 to 2016. For each hospital we determined the annual absolute KA volume (TKR+PKR) into quartiles (<103, 103–197, 197–292, >292 knee replacements/year), and determined whether the TKR supplier provided a frequently used PKR. Hospitals were divided in routine PKR users (≥13 PKRs/year) or occasional/non PKR users (<13 PKRs/year). Based on these parameters, the effect of total KA volume and supplier on PKR usage was investigated, using chi-square tests. Logistic regression analysis was performed to evaluate the influence of the combination of these factors. Results In the lowest volume group, around 15% of the hospitals used PKRs, compared to 75% in the highest volume group. Having a TKR supplier that also provides a frequently used PKR resulted in a higher likelihood of performing PKR, especially in low volume hospitals. Conclusions Hospitals’ total KA volume and the availability of a frequently used PKR appear to influence the use of PKR.

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confidence: 99%

“…Generally, better outcomes have been observed at high-volume centers (HVCs) when compared with low-volume centers (LVCs), and a trend toward conducting TJA at HVCs has been observed in recent years. [3][4][5] Efforts to improve the quality of outcomes after TJA have led to calls for "centralization," "regionalization," or "consolidation" of these procedures to HVCs. [5][6][7][8] However, there may be issues with the implementation and consequences of such centralization.…”

mentioning

confidence: 99%

Comorbidity, Racial, and Socioeconomic Disparities in Total Knee and Hip Arthroplasty at High Versus Low‐Volume Centers

Zalikha

Almsaddi

Nham

et al. 2022

J Am Acad Orthop Surg

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Introduction:The purpose of this study was to compare the epidemiologic and demographic profiles and inpatient postoperative complication and economic outcomes of patients undergoing total joint arthroplasty of the hip and knee (TJA) at high-volume centers (HVCs) versus low-volume centers (LVCs) using a large national registry. Methods: This retrospective cohort study used data from the National Inpatient Sample from 2006 to the third quarter of 2015. Discharges representing patients aged 40 years or older receiving a primary total hip arthroplasty or total knee arthroplasty were included. Patients were stratified into those undergoing their procedure at HVCs versus LVCs. Epidemiologic, demographic, and inpatient postoperative complications and economic outcomes were comparatively analyzed between groups. Results: A total of 7,694,331 TJAs were conducted at HVCs while 1,044,358 were conducted at LVCs. Patients at LVCs were more likely to be female, be Hispanic, be non-Hispanic Black, and use Medicare and Medicaid than patients at HVCs. Of the 29 Elixhauser comorbidities examined, 14 were markedly higher at LVCs while 11 were markedly higher at HVCs. Patients who underwent TJA at LVCs were more likely to develop cardiac, respiratory, gastrointestinal, genitourinary, hematoma/seroma, wound dehiscence, and postoperative infection complications and were more likely to die during hospitalization. Patients at HVCs were more likely to develop postoperative anemia. Length of stay and total charges were higher at LVCs compared with HVCs. Discussion: There are notable differences in the demographics, epidemiologic characteristics, and inpatient outcomes of patients undergoing TJA at HVCs versus LVCs. Attention should be directed to identifying and applying the specific resources, processes, and practices that improve outcomes at HVCs while referral practices and centralization efforts should be mindful to not worsen already existing disparities.

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Hospital volume–outcome relationship in total knee arthroplasty: a systematic review and dose–response meta-analysis

Cited by 15 publications

References 114 publications

Italian Translation, Adaptation, and Validation of the Novel Satisfaction Measure Assessment after Primary Total Joint Arthroplasty: The Goodman Score Questionnaire

Italian Translation, Adaptation, and Validation of the Novel Satisfaction Measure Assessment after Primary Total Joint Arthroplasty: The Goodman Score Questionnaire

Nationwide partial knee replacement uptake is influenced by volume and supplier––A Dutch arthroplasty register study

Comorbidity, Racial, and Socioeconomic Disparities in Total Knee and Hip Arthroplasty at High Versus Low‐Volume Centers

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