Department of Orthopedic Surgery, Emory Orthopaedics & Spine Centre, Atlanta, GA.
J Arthroplasty. 2020 Oct;35(10):2952-2959. doi: 10.1016/j.arth.2020.05.008. Epub 2020 May 12.
The aim of this study is to define the evidence-based institutional volume-outcome relationship in revision hip arthroplasty. We hypothesized that high-volume centers would be associated with superior outcomes, and that stratum-specific likelihood ratio (SSLR) analysis would delineate concrete volume thresholds for optimizing outcomes.
The Nationwide Readmission Database was queried from 2011 to 2016 for patients undergoing revision hip arthroplasty. SSLR analysis was used to determine hospital volume cutoffs specific for outcomes of interest. Volume categories were confirmed with multivariate regression.
SSLR analysis produced distinct hospital volume cutoffs for all outcomes. Each subsequent volume threshold diminished patients' risk for adverse outcomes. Tertiles were identified for 90-day infection (≤6, 7-51, ≥52 cases per year). Quartiles were found for 90-day readmission (≤5, 6-15, 16-79, ≥80), 90-day prosthesis-related complication (≤5, 6-16, 17-65, ≥66), 90-day dislocation (≤5, 6-19, 20-79, ≥80), and non-home discharge (≤5, 6-15, 16-40, and ≥41). Quintiles were generated for extended length of stay >2 days (≤2, 3-10, 11-20, 21-30, ≥31). Heptiles were produced for medical complications within 90 days (≤2, 3-8, 9-16, 17-51, 52-89, ≥90).
This is the first known study to define evidence-based thresholds for the impact of hospital volume on revision joint arthroplasty. This supports the notion that institutional volume functions as a surrogate for protocolized interdisciplinary coordination of care and surgical experience, and that high-volume centers offer enhanced outcomes for complex cases. Additional studies should investigate the potential role for incentivization of such institutions, as they offer optimal outcomes for revision hip arthroplasty.
本研究旨在确定翻修髋关节置换术的循证机构量效关系。我们假设高容量中心与更好的结果相关，并且分层似然比 (SSLR) 分析将划定具体的容量阈值以优化结果。
从 2011 年至 2016 年，国家再入院数据库被查询以寻找接受翻修髋关节置换术的患者。使用 SSLR 分析确定具体针对感兴趣结果的医院容量截止值。使用多元回归确认容量类别。
SSLR 分析为所有结果产生了明显的医院容量截止值。每个后续的容量阈值降低了患者不良结果的风险。90 天感染的三分位数确定（≤6、7-51、≥52 例/年）。90 天再入院的四分位数发现（≤5、6-15、16-79、≥80）、90 天假体相关并发症（≤5、6-16、17-65、≥66）、90 天脱位（≤5、6-19、20-79、≥80）和非家庭出院（≤5、6-15、16-40、≥41）。90 天内医疗并发症的五分位数（≤2、3-10、11-20、21-30、≥31）生成。90 天内医学并发症的七分位数（≤2、3-8、9-16、17-51、52-89、≥90）生成。
这是第一项已知的研究，确定了医院容量对翻修关节置换术影响的循证阈值。这支持这样一种观点，即机构容量作为协议化跨学科护理协调和手术经验的替代指标，大容量中心为复杂病例提供了更好的结果。应进一步研究激励这些机构的潜在作用，因为它们为翻修髋关节置换术提供了最佳结果。
