Researchers at University of Iowa Health Care recently reported on a study looking at orthopaedic surgical outcomes of Medicare patients who had undergone hip or knee replacement. Peter Cram, MD, the study's senior author and a physician at University of Iowa Hospitals and Clinics, talks about the study and the outcome:
How many patients and hospital settings were studied as part of this study?
Dr. Tyson Hagen, who's a rheumatology fellow, and Dr. Mary Vaughan Sarrazin and I analyzed data on about 1.2 million Medicare patients who underwent hip or knee replacement between 2001 and 2005 at about 3,800 U.S. hospitals.
What was the range of ages in patients who had received a hip or knee replacement in the data gathered?
The average age of patients in our database was about 75. Those patients ranged from about 65 years old, which is the age at which patients generally become eligible for Medicare, up to patients in their 90s.
What was reviewed in each case as part of the study?
What we were looking at was complication rates after hip and knee replacement surgery. Those complications range from death, which is rare—incredibly rare—much less than one percent, to more common complications like blood clots, infections, or bleeding after these surgeries.
How were hospitals grouped for their level of specialty in orthopaedic surgeries?
What was new about this study and what people, I guess, at the British Medical Journal found interesting is that we were looking at specialization—do more specialized hospitals have better outcomes than less specialized hospitals? And by specialized, what we mean is what percent of a hospital's business was hip or knee surgery? Was it one percent of their business or 100 percent of their business—100 percent meaning the hospital did nothing but hip or knee replacement surgery; zero or one percent meaning the hospital did very little hip or knee replacement surgery.
What did the study show with regard to overall outcome for Medicare patients undergoing hip or knee replacement surgery?
What we found that was potentially interesting and exciting was that more specialized hospitals seem to have lower complication rates. As you move across a range from zero percent specialization to 20 percent to 60 to 80 to 100 percent, as specialization increased, complication rates declined and that's important and new.
Why might a hospital that has a higher number of orthopaedic-specific patients have better outcomes?
When I talked to my mother-in-law about this, I talked about Kentucky Fried chicken (I don't know, I'm probably dating myself), but you know 'we do chicken right' used to be KFC's advertising campaign, and the idea is that there may be real benefits to hospitals focusing on specific areas and that might be orthopaedics, or cardiology, it might be cancer care; but the idea of having teams that focus on diseases in patients—we think that that probably has real benefits and that that's what we were seeing in our studies—that hospitals that focus on orthopaedics might get really good at this.
Did the location of the hospital affect the outcome of surgery and follow-up care?
We did not, in this study, look at geographic factors, but there's been a lot of evidence—some great stuff done by researchers at Dartmouth showing that there are significant regional variations in care. And if we want to feel good about living in the Midwest, we tend to be frugal in the Midwest, meaning that we tend to do less care than other regions of the country and at the same time, our patients tend to have just as good outcomes. But we weren't specially looking at geographic factors in this study.
Based on this study, what would your recommendation be for anyone considering a knee or hip replacement surgical procedure?
I think that this mirrors some prior studies that patients probably want to seek out an experienced surgeon who does lots of these procedures, in an institution that does lots of these procedures. And that often is an academic medical center, but not always. |
