Association between hospital and surgeon procedure volume with outcome of total hip replacement

Objective: The goal of this study was to determine whether the volumes of total hip replacement (THR) of the quality of health care at hospitals and surgeons are associated with rate of mortality and complications. Methods: We analyzed claims data from the National Health Insurance (NHI) for patients who underwent elective primary THR procedures between Jan 1998 and Dec 2000. We assessed the relationship between surgeon and hospital procedure volume, as well as the rate of mortality, readmission, and dislocation within ninety days and one year postoperatively. Analyses were adjusted for age, gender, arthritis diagnosis, severity of disease, the area, owner and size of hospital, LOS (length of stay), in-hospital rehabilitation and complication. Result: Ninety days after discharge, patients treated in hospitals in which there were more than 50 of these procedures had a lower risk of death and readmission than those treated in hospitals in which there were seven or few procedures (mortality rate, 0.66% compared with 1.00%; adjusted OR=0.69; readmission rate, 13.93% compared with 48.31%; adjusted OR=0.69). Ninety days after discharge, patients treated by surgeons who performed more than 25 of these procedures had a lower risk of death and readmission than those treated by surgeons who performed less than 10 procedures (mortality rate, 0.57% compared with 2. 55%; adjusted OR=0.23; readmission rate, 13.67% compared with 42.34%; adjusted OR=0. 73). Conclusion: Patients treated in hospitals and by surgeons with lower caseload of THR had higher rates of mortality and readmission. We suggest that NHI should concentrate THR in high-volume referral centers in order to reduce avoidable mortality and morbidity.