Association of hospital and surgeon procedure volume with patient-centered outcomes of total knee replacement in a population-based cohort of patients age 65 years and older
✍ Scribed by Jeffrey N. Katz; Nizar N. Mahomed; John A. Baron; Jane A. Barrett; Anne H. Fossel; Alisha H. Creel; John Wright; Elizabeth A. Wright; Elena Losina
- Publisher
- John Wiley and Sons
- Year
- 2007
- Tongue
- English
- Weight
- 101 KB
- Volume
- 56
- Category
- Article
- ISSN
- 0004-3591
No coin nor oath required. For personal study only.
✦ Synopsis
Abstract
Objective
To study the association between procedure volume and patient‐centered outcomes such as functional status.
Methods
We performed an observational study of a stratified random sample of Medicare beneficiaries who underwent primary total knee replacement (TKR) in 2000. Low‐volume surgeons were defined as surgeons performing ≤6 TKRs per year in the Medicare population, and low‐volume centers were defined as those in which ≤25 TKRs per year were performed. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) functional status score (0–100 scale; 100 = best) 2 years after TKR. We defined a WOMAC functional status score of <60 as a poor functional outcome. Analyses were adjusted for sociodemographic factors, preoperative functional status, and comorbidities.
Results
Fifty‐eight percent of 1,597 eligible patients agreed to participate. Twelve percent of participating patients had a WOMAC score <60 2 years following TKR. Patients operated upon by low‐volume surgeons in low‐volume hospitals were twice as likely to have a poor WOMAC functional status score as patients operated upon by higher volume surgeons and in higher volume hospitals (odds ratio 2.1, 95% confidence interval 1.1–4.2).
Conclusion
Patients operated upon in low‐volume hospitals by low‐volume surgeons had worse functional outcomes 2 years after TKR. These findings add a new and important dimension to the discussion of whether to promote selective referral of procedures such as TKR to high‐volume centers.