Relationship between peri-operative outcomes and hospital surgical volume of total hip arthroplasty in Japan

Takeshi Kaneko, Kazuo Hirakawa, Kiyohide Fushimi
Health Policy 2014, 117 (1): 48-53

BACKGROUND: This study aimed to evaluate the relationship between peri-operative complication of total hip arthroplasty (THA) and hospital surgical volume.

METHODS: We reviewed discharge administrative data from 8321 patients who underwent primary THA between July and December 2008. Relationships between complications and surgical volume were analyzed with multivariate logistic regression models including age, sex, and Charlson comorbidity index. Hospitals were categorized into four groups according to the 6-month volume of THA procedures.

RESULTS: The most frequent complication was dislocation (1.41%). Next was infection (1.24%). Fracture and pulmonary embolism occurred in less than 1% of procedures. Patients who underwent THA in hospitals with the highest surgical volume had lower risk of dislocation and infection than those treated in the hospitals with the lowest surgical volume (odds ratio [OR] 0.321, 95% confidence interval [CI] 0.167-0.572 and OR 0.123, 95% CI 0.020-0.421). Patients aged 65 years and older were associated with increased risk of dislocation (OR 2.342, CI 1.555-3.624) and fracture (OR 2.799, CI 1.372-6.301). Females demonstrated lower risk of dislocation (OR 0.558, CI 0.352-0.869) and infection (OR 0.560, CI 0.365-0.882).

CONCLUSION: These results indicated that the increase in the risk of peri-operative dislocation of primary THA may be associated with low hospital surgical volume as well as age and male sex.

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