Risk for Complication after Total Joint Arthroplasty at a Center of Excellence: The Impact of Patient Travel Distance

Abstract Healthcare reorganization and bundled payment schemes have resulted in increased patient travel distances in orthopedics. Travel distance has been previously associated with increased complication risk but has yet to be studied in orthopedics. We analyzed the impact of patient travel distan...

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Bibliographic Details
Published in:The Journal of arthroplasty 2015-06, Vol.30 (6), p.1058-1061
Main Authors: Nwachukwu, Benedict U., MD, MBA, Dy, Christopher J., MD, MPH, Burket, Jayme C., PhD, Padgett, Douglas E., MD, Lyman, Stephen, PhD
Format: Article
Language:English
Subjects:
Aged
Arthroplasty, Replacement, Hip - adverse effects
Arthroplasty, Replacement, Hip - economics
Arthroplasty, Replacement, Knee - adverse effects
Arthroplasty, Replacement, Knee - economics
complication
Delivery of Health Care - economics
Female
Health Services Accessibility
Humans
Male
Medicaid
Medicare - economics
Middle Aged
Odds Ratio
Orthopedics
Orthopedics - economics
Postoperative Complications
Prospective Studies
Reimbursement Mechanisms
Retrospective Studies
revision
Risk Factors
socioeconomics
total hip arthroplasty
total knee arthroplasty
travel distance
United States
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Summary:Abstract Healthcare reorganization and bundled payment schemes have resulted in increased patient travel distances in orthopedics. Travel distance has been previously associated with increased complication risk but has yet to be studied in orthopedics. We analyzed the impact of patient travel distance on short-term complications. We reviewed 38,887 TJAs performed between 2008 and 2011 and identified 1606 complications in 1110 procedures. There was no significant association between complication risk and patient travel distance. Complication risk was associated with age, ASA class, Medicare and Medicaid status ( P < 0.0001 for all). Regional centers of excellence appear to be a viable model in healthcare reorganization however continued attention should be paid to attenuating the individual patient factors associated with complication at these institutions.
ISSN:0883-5403
1532-8406
DOI:10.1016/j.arth.2015.01.015