Improving Value in Total Hip and Knee Arthroplasty: The Role of High Volume Hospitals

Courtney, P. Maxwell; Frisch, Nicholas B.; Bohl, Daniel D.; Valle, Craig J. Della

doi:10.1016/j.arth.2017.07.040

Cited by 54 publications

(53 citation statements)

References 21 publications

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“…These regional differences have been attributed to variability in patient demographics, as well as hospital volumes [18]. Low hospital volume has been shown to have higher average hospital-specific charges, total inpatient payments, and total Medicare payments following TJA [5]. The same study also demonstrated that these low volume hospitals were more likely to be found in nonurban areas and in the West South Central region [5].…”

Section: Discussionmentioning

confidence: 97%

“…Additionally, the volume of arthroplasty procedures performed in the hospital per year plays a role in hospital and surgeon costs. Courtney et al [5] showed that lower volume hospitals (<100 cases per year) were more likely to be in the upper quartile for Medicare inpatient costs even when controlling for demographic and geographic factors. They demonstrated that higher volume hospitals had lower complication scores and trended toward lower readmission rates [5].…”

Section: Discussionmentioning

confidence: 99%

“…Courtney et al [5] showed that lower volume hospitals (<100 cases per year) were more likely to be in the upper quartile for Medicare inpatient costs even when controlling for demographic and geographic factors. They demonstrated that higher volume hospitals had lower complication scores and trended toward lower readmission rates [5]. Several studies have revealed significant cost reductions with the use of ambulatory surgery centers compared to inpatient hospitalizations for arthroplasty procedures [10,11].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Surgeon Reimbursement Unchanged as Hospital Charges and Reimbursements Increase for Total Joint Arthroplasty

Quinlan

Chen

Browne

et al. 2020

The Journal of Arthroplasty

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Surgeon Reimbursement Unchanged as Hospital Charges and Reimbursements Increase for Total Joint Arthroplasty

Quinlan

Chen

Browne

et al. 2020

The Journal of Arthroplasty

View full text Add to dashboard Cite

“…Three studies reporting differences in the cost of surgery could not be included in the meta-analysis. Courtney et al [48] reported that THA procedures performed at HVH had significantly lower total mean hospital-specific charges. Frisch et al [49] and Lavernia et al [50] found no significant difference between mean hospital charges for THA performed at LVH and HVH.…”

Section: Resultsmentioning

confidence: 99%

Effect of hospital volume on outcomes of total hip arthroplasty: a systematic review and meta-analysis

et al. 2019

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BackgroundA shift in the healthcare system towards the centralization of common yet costly surgeries, such as total hip arthroplasty (THA), to high-volume centers of excellence, is an attempt to control the economic burden while simultaneously enhancing patient outcomes. The “volume-outcome” relationship suggests that hospitals performing more treatment of a given type exhibit better outcomes than hospitals performing fewer. This theory has surfaced as an important factor in determining patient outcomes following THA. We performed a systematic review with meta-analyses to review the available evidence on the impact of hospital volume on outcomes of THA.Materials and methodsWe conducted a review of PubMed (MEDLINE), OVID MEDLINE, Google Scholar, and Cochrane library of studies reporting the impact of hospital volume on THA. The studies were evaluated as per the inclusion and exclusion criteria. A total of 44 studies were included in the review. We accessed pooled data using random-effect meta-analysis.ResultsResults of the meta-analyses show that low-volume hospitals were associated with a higher rate of surgical site infections (1.25 [1.01, 1.55]), longer length of stay (RR, 0.83[0.48–1.18]), increased cost of surgery (3.44, [2.57, 4.30]), 90-day complications (RR, 1.80[1.50–2.17]) and 30-day (RR, 2.33[1.27–4.28]), 90-day (RR, 1.26[1.05–1.51]), and 1-year mortality rates (RR, 2.26[1.32–3.88]) when compared to high-volume hospitals following THA. Except for two prospective studies, all were retrospective observational studies.ConclusionsThese findings demonstrate superior outcomes following THA in high-volume hospitals. Together with the reduced cost of the surgical procedure, fewer complications may contribute to saving considerable opportunity costs annually. However, a need to define objective volume-thresholds with stronger evidence would be required.Trial registrationPROSPERO CRD42019123776.

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“…Recently, healthcare reform in the United States has focused on improving the quality of care while concurrently reducing overall costs [1,2]. To achieve this goal, healthcare policy experts have advocated for the development and increased utilization of centers of excellence or care institutions that meet evidence-based quality criteria, including high volume, physician training, and staff ratios [3].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Travel Distance on Outcomes for Hip Resurfacing Arthroplasty at a High-Volume Center

et al. 2020

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Background: Patients are increasingly traveling greater distances to receive care at high-volume centers. The effect of travel distance on patient-reported outcomes after hip resurfacing arthroplasty has not been described. Methods: Patients undergoing HRA by a single surgeon from January 2007 to April 2018 with minimum 2-year follow-up were reviewed retrospectively. Five hundred ninety-nine patients were identified and divided into 2 cohorts: home-to-hospital distance >100 miles and 100 miles from our institution. Preoperative and 2-year postoperative patient-reported outcome measures (PROMs) were assessed, including the modified Harris Hip Score and Hip disability and Osteoarthritis Outcome Score. The minimal clinically important difference (MCID) for each PROM was calculated using the distributionbased method. Chi-square tests were used for univariate comparison. Poisson regressions controlling for demographic variables were performed to determine the effect of travel distance on whether patients achieved the MCID. Multivariate linear regressions were used to determine association between distance and improvement in PROMs. Results: A total of 599 patients met criteria for inclusion. There were 113 (18.9%) with a home-to-hospital distance >100 miles and 486 (81.1%) with distance 100 miles. Age was the only demographic factor different between these groups (mean: 1.1-year difference, P < .001). There were no significant differences in reaching the MCID on any PROM between these groups. Multivariate linear regressions revealed no associations between travel distance and improvement in PROMs. Conclusions: Travel distance to a high-volume center did not affect 2-year patient-reported outcomes or rate of achieving the MCID in patients undergoing hip resurfacing arthroplasty.

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Improving Value in Total Hip and Knee Arthroplasty: The Role of High Volume Hospitals

Cited by 54 publications

References 21 publications

Surgeon Reimbursement Unchanged as Hospital Charges and Reimbursements Increase for Total Joint Arthroplasty

Surgeon Reimbursement Unchanged as Hospital Charges and Reimbursements Increase for Total Joint Arthroplasty

Effect of hospital volume on outcomes of total hip arthroplasty: a systematic review and meta-analysis

The Effect of Travel Distance on Outcomes for Hip Resurfacing Arthroplasty at a High-Volume Center

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