D'Apuzzo Michele R, Higgins Matthew D, Novicoff Wendy M, Browne James A
Department of Orthopedic Surgery, University of Miami, Miami, FL, USA.
Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA, USA.
Arthroplast Today. 2022 May 26;16:53-56. doi: 10.1016/j.artd.2022.03.003. eCollection 2022 Aug.
Although the effects of hospital volume on mortality have been studied in other procedures, data on total joint arthroplasty (TJA) are limited. Furthermore, mortality rate among surgical patients with early major complications has become an important patient safety indicator and has been shown to be an important driver of mortality in certain operations. Our objective was to examine the effect of hospital volume on early complications and in-hospital mortality rate after TJA.
A total of 5,396,644 patients undergoing elective, unilateral TJA between 2002 and 2011 were identified using the Nationwide Inpatient Sample database. Hospitals were divided by annual volume into tertiles. Major complications associated with postoperative mortality were identified. Risk-adjusted mortality (RAM) was calculated to adjust for hospital case mix.
For THAs performed at high-volume centers, RAM was significantly lower (0.03% vs 0.41%, < .05, high vs low volume) with lower prevalence of major complications (2.2% vs 3.3%, < .05, high vs low volume). We observed similar results for TKA where RAM was lower (<0.01% vs 0.06%, < .05, high vs low volume). Major complications, however, were not significant (1.4% vs 1.5%, < .83). Pneumonia was the most prevalent complication for THA (1.5% vs 0.9%, < .05, high vs low volume) and TKA (0.9% vs 0.5%, < .05 high vs low volume).
Hospital volume appears to drive a large proportion of the variation in early in-hospital mortality after TJA. This variation does not seem to be explained by hospital case mix and rather by the higher prevalence of major postoperative complications in lower volume institutions.
尽管医院手术量对死亡率的影响已在其他手术中得到研究，但全关节置换术（TJA）的数据有限。此外，早期发生严重并发症的手术患者的死亡率已成为一项重要的患者安全指标，并且在某些手术中已被证明是死亡率的重要驱动因素。我们的目的是研究医院手术量对TJA术后早期并发症和住院死亡率的影响。
使用全国住院患者样本数据库，确定了2002年至2011年间共5396644例行择期单侧TJA的患者。医院按年手术量分为三分位数。确定与术后死亡率相关的主要并发症。计算风险调整死亡率（RAM）以调整医院病例组合。
对于在高手术量中心进行的全髋关节置换术（THA），RAM显著更低（0.03%对0.41%，P<0.05，高手术量对低手术量），主要并发症的发生率也更低（2.2%对3.3%，P<0.05，高手术量对低手术量）。我们在全膝关节置换术（TKA）中观察到类似结果，其中RAM更低（<0.01%对0.06%，P<0.05，高手术量对低手术量）。然而，主要并发症并无显著差异（1.4%对1.5%，P<0.83）。肺炎是THA（1.5%对0.9%，P<0.05，高手术量对低手术量）和TKA（0.9%对0.5%，P<0.05，高手术量对低手术量）中最常见的并发症。
医院手术量似乎在很大程度上导致了TJA术后早期住院死亡率的差异。这种差异似乎不是由医院病例组合解释的，而是由低手术量机构中术后严重并发症的较高发生率导致的。
