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Get Better Results with Joint Replacements at Specialty Hospitals

There's a general trend toward more patients having total hip or total knee replacements at a specialty hospital instead of a general hospital. In this study, results of joint replacement surgery for Medicare patients were compared for these two locations.

The use of specialty care hospitals for surgery of this type has come under sharp criticism. Some people suspect patients who go to a specialty center have more money. They may be healthier, so their risk of complications is less. The center makes more money because they don’t treat the poor and needy.

Others claim that specialty centers can focus on improving their results at a reduced cost compared to a general hospital. The results of this study support the idea that patients at a specialty hospital come from a more affluent background (based on zip codes).

Over 50,000 Medicare patients who had a total hip replacement were included. There were also nearly 100,000 Medicare patients reviewed who received a total knee replacement reviewed.

Results were measured by how many problems occurred within 90 days of the surgery. Infection, hemorrhage, blood clots, and death were tracked. Length of hospital stay was recorded. And they looked to see if patients had to be transferred from the hospital to another facility to handle special problems.

After careful analysis, they found that patients using the specialty hospitals had better outcomes compared to patients in the general hospitals. The death rate was lower. They were less likely to have the complications listed. This may be explained by the fact that they were less likely to have general health problems such as diabetes, heart disease, or kidney failure.

The authors offer several other explanations for the better results in specialty hospitals. It could be just the sheer volume of cases gives them the edge. Or perhaps the staff has greater experience and expertise in the specialty hospitals. Communication among the clinical teams could be a key factor as well.

On the other hand, patients were transferred from the specialty hospital to another acute-care hospital more often than patients who were treated in a general hospital first. The reason for this may be the lack of staff and equipment to handle special problems. Or perhaps they transferred patients who were more complicated and expensive. They lose money under the current Medicare payment system with delayed discharge.

The authors suggest more study is needed to understand the reasons behind the differences in results between specialty and general hospitals. It would be good to do this same study with patients who aren't on Medicare. This would help show how much that factor plays a role in the results.

References: Peter Cramm, MD, MBA, et al. A Comparison of Total Hip and Knee Replacement in Specialty and General Hospitals. In The Journal of Bone and Joint Surgery. August 2007. Vol. 89-A. No. 8. Pp. 1675-1684.

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