The Who and Where of Total Knee Replacement Surgery

Surgeons who do more of a certain surgery become more skilled at it. The same is true for hospitals. Many insurance companies and HMOs would like patients to go to these surgeons and hospitals. The idea is that patients who go to more skilled surgeons and surgery staff will have fewer problems after surgery. This means less cost--and it's better for the patient, too.

These authors wanted to see how this theory held up in the case of total knee replacement (TKR) surgery. They used a nation-wide database to track more than 50,000 patients after TKR. They used records from all kinds of hospitals in all parts of the United States. They grouped surgeons and hospitals by the number of TKRs they did in a year. The researchers also looked at data about the patients, such as their age, gender, health, and income. They crunched quite a few numbers:

  • Most of the patients were white women. The average age was 69.
  • Overall, the rate of death after TKR was only 0.2 percent. The average hospital stay was almost five days.
  • Complications didn't happen very often after surgery. Only about one percent of patients had complications such as blood clots and infection.
  • Just under half of the total number of TKRs were done by surgeons who did less than 30 TKRs a year, in hospitals that did fewer than 150 a year.

    The only major connection the authors found was between death rates and number of surgeries done. Surgeons who did at least 15 TKRs a year and hospitals that did at least 85 a year had lower rates of patient deaths after TKR.

    As far as these authors know, this is the first study of its kind. More studies are needed to consider problems that happen after patients are sent home from the hospital. Studies like this one could help surgeons, insurance companies, and patients choose the best person and the best place to do certain types of surgeries.



    References: Sheleika L. Hervey, MD, et al. Provider Volume of Total Knee Athroplasties and Patient Outcomes in the HCUP-Nationwide Inpatient Sample. In The Journal of Bone and Joint Surgery. September 2003. Vol. 85-A. No. 9. pp. 1775-1783.

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