Association of hospital and surgeon volume of total hip replacement with functional status and satisfaction three years following surgery

• Published in: Arthritis and rheumatism 2003-02, Vol.48 (2), p.560-568
• Main Authors: Katz, Jeffrey N., Phillips, Charlotte B., Baron, John A., Fossel, Anne H., Mahomed, Nizar N., Barrett, Jane, Lingard, Elizabeth A., Harris, William H., Poss, Robert, Lew, Robert A., Guadagnoli, Edward, Wright, Elizabeth A., Losina, Elena
• Format: Article
• Language: English
• Subjects: Aged; Arthroplasty, Replacement, Hip - economics; Arthroplasty, Replacement, Hip - standards; Arthroplasty, Replacement, Hip - statistics & numerical data; Biological and medical sciences; Cohort Studies; Female; General Surgery - statistics & numerical data; Hospitals - statistics & numerical data; Humans; Inpatients - statistics & numerical data; Male; Medical sciences; Multivariate Analysis; Orthopedic surgery; Outcome and Process Assessment (Health Care); Patient Satisfaction; Recovery of Function; Social Class; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
• ISSN: 0004-3591; 1529-0131
• DOI: 10.1002/art.10754

Objective To evaluate whether hospital volume and surgeon volume of total hip replacements (THRs) are associated with patient‐reported functional status and satisfaction with surgery 3 years postoperatively. Methods We performed a population‐based cohort study of a stratified random sample of Medicare beneficiaries who underwent elective primary or revision THR in Ohio, Pennsylvania, or Colorado in 1995. The primary outcomes were the self‐reported Harris hip score and a validated scale measuring satisfaction with the results of surgery. Both outcomes were assessed 3 years postoperatively. Hospital volume was defined as the aggregate number of elective primary and revision THRs performed on Medicare beneficiaries in the hospital in 1995. High‐volume hospitals were defined as those in which >100 such procedures are performed annually, and low‐volume centers were defined as those in which ≤12 procedures (primary THR cohort) or ≤30 procedures (revision cohort) are performed annually. Results In unadjusted analyses, patients who underwent surgery in low‐volume centers had worse functional status 3 years following primary and revision THR compared with patients whose surgery was performed in higher‐volume centers. Patients whose revision THR was performed by a low‐volume surgeon also had worse function. After adjustment for sociodemographic and clinical variables, however, the association between higher hospital volume and better functional status following primary THR was weak and statistically nonsignificant, and no statistically significant or clinically important associations between hospital or surgeon volume and functional status following revision THR was observed. Patients who underwent elective primary THR in low‐volume centers were more likely to be dissatisfied with the results of surgery compared with patients whose surgeries were performed in high‐volume centers. Similarly, patients whose surgeons performed ≤12 procedures per year were more likely to be dissatisfied with the results of revision THR than were patients whose surgeons performed >12 procedures per year. Conclusion Hospital volume and surgeon volume have little effect on 3‐year functional outcome following THR, after adjusting for patient sociodemographic and select clinical characteristics. However, satisfaction with primary THR is greater among patients who underwent surgery in high‐volume centers, and satisfaction with revisions is greater among patients whose operations were performe