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Need a Hip Replacement? Who Ya Gonna Call?

Posted on: 11/30/1999
Should you travel to a big hospital for your hip replacement surgery? Or is it just as good to go to the smaller hospital near your home? Studies have shown that patients having some surgical procedures fare better when treated in hospitals that perform a lot of similar procedures. Patients also do better when the surgeon routinely performs that type of procedure. Is the number of surgeries done by the hospital and/or surgeon important to hip replacement surgery?

These authors studied the results of Medicare patients who had total hip replacement or additional surgery on a new hip ("revision" surgery). About 59,000 patients had total hip replacements. About 13,000 had revisions. The average age of the patients was 74. Patients were mostly female and white. Most had arthritis. None had hip fractures.

Many of the patients were treated by hospitals and surgeons that didn't do a lot of hip surgeries. About ten percent of the hip replacements and half of the revisions were done in "low load" hospitals, in which less than ten of these surgeries were done a year. Half of the hip replacements and three-quarters of the revisions were done by "low load" surgeons, who did less than ten a year.

Patients who had hip replacements in "high load" hospitals (more than 100 procedures a year) had lower rates of death and hip dislocation than those in "low load" hospitals (fewer than ten procedures a year). Patients in "high load" hospitals were also somewhat less likely to have infections.

Patients whose hip replacements were done by "high load" surgeons (more than 50 procedures a year) had fewer dislocations than those operated on by "low load" surgeons. They were also a little less likely to have other complications.

The results for revisions were basically the same. One difference was that the number of procedures done by the surgeon (instead of by the hospital) was related to patient death.

There was no magic number of procedures that changed patients' outcomes from better to worse. Patients' results declined steadily as the number of procedures went down. The number of procedures per surgeon made the most difference in hospitals with less than 100 hip surgeries a year. In hospitals that did more hip surgeries, the number done by each surgeon didn't matter.

The authors feel that there might be fewer deaths and complications from hip surgery if more patients went to hospitals and surgeons that treated a lot of these cases. Still, the authors can't say what it is about high volume that improves patients' outcomes. The authors also don't know whether high volume means better pain control and function for patients. Clearly, more studies are needed.

Jeffrey N. Katz, MD, MS, et al. Association Between Hospital and Surgeon Procedure Volume and Outcomes of Total Hip Replacement in the United States Medicare Population. In The Journal of Bone and Joint Surgery. November 2001. Vol. 83-A. No. 11. Pp. 1622-1629.

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