AJRR Conducts Study on Hospital Size and Revision Procedure Correlation

Author: Kathryne Auerback

The American Joint Replacement Registry (AJRR), a hip and knee replacement database part of the American Academy of Orthopaedic Surgeons’ (AAOS) registries portfolio, has conducted a study analyzing the correlation between hospital size, the reason for revision (or re-do) surgery, and where total joint arthroplasty (TJA) revision surgery is performed. The link between these three factors has not been studied extensively until now.

Medicare hospital claims data and beneficiary enrollment data were used for the study. Medicare patients undergoing a TJA revision can sometimes have it performed by a different surgeon or at a different hospital than the primary (or initial) procedure. The frequency of early infection and dislocation revisions performed following surgery by the same surgeon in the same hospital as the primary surgery is unclear. The study looks at whether there is an association between hospital size and where the revision is performed, and how frequently Medicare patients return to the same hospital or surgeon in the first year for joint infection or dislocation.

“Data on revision rates that depend exclusively on information from the same hospitals where the primary procedures are performed will under report the actual revision rates occurring,” said lead study author and Adjunct Professor of Orthopaedic Surgery, University of Minnesota Medical School, Terence J. Gioe, MD.

A few of the study results include:

  • In hospitals with less than 150 beds, about 76% of revisions within one year were performed at the same hospital. This increases with hospital size.
  • In hospitals with over 450 beds, about 88% of revisions were performed at the same institution.
  • For infection-related revisions within the first year, about 83% were at the same hospital, and about 80% were by the same surgeon.
  • With dislocation-related total hip arthroplasty (THA) revisions, about 87% were performed in the same hospital, and about 83% were performed by the same surgeon.

“Although this study looked at Medicare data as opposed to AJRR data, the findings will inform future Registry research projects and will lay the groundwork as the AJRR becomes more diverse and comprehensive,” said AJRR Director of Analytics Caryn D. Etkin, PhD, MPH. “It will be interesting to share the results of the study with our international counterparts, and to see if similar trends have occurred on a global scale.”

A poster of this study titled, “Is There a Correlation Between Hospital Size and Revision Indication and Where TJA Revision Surgery is Performed?” will be on display at the AAOS 2018 Annual Meeting in Academy Hall B – Poster #P0168. The poster can also be accessed here.

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