Patients who undergo orthopedic surgeries at high-volume hospitals have better outcomes

Patients who undergo elective orthopedic surgeries at high-volume, regional hospitals have better surgical outcomes and experience fewer complications than those who undergo those surgeries at local hospitals, according to research being presented by Hospital for Special Surgery investigators at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

These "regionalizers"--patients who travel to a regional, high-volume hospital--also tend to be younger, white, male and have private insurance, according to the research from Hospital for Special Surgery (HSS) in New York, which performs the highest number of joint replacements in the country.

Analyzing more than 974,000 patients who received elective total shoulder or total hip arthroplasty over two studies, the researchers found significant differences in rates of infection and death during hospitalization, depending on whether patients had surgery at a local hospital or at a regional high-volume hospital.

The studies, which collected information from statewide hospitalization databases in 13 U.S. states, were led by Stephen Lyman, Ph.D., director of Epidemiology and Biostatistics, and Robert Marx, M.D., an orthopedic surgeon in the Sports Medicine and Shoulder Service, both from Hospital for Special Surgery.

"Compared to local hospitals, high-volume regional centers are associated with improved outcomes and decreased post-operative complications," said Dr. Marx. "Our analyses showed that regionalizers are less likely to have infections or complications."

Patients who traveled to regional centers for surgery--and thus had better outcomes--were disproportionately younger, male and white. These results were statistically significant, even after adjusting for factors like age, sex, race, year of surgery and hospital volume.

"More and more, patients consider healthcare to be a commodity. They see medical centers as interchangeable, and believe that surgical outcomes are uniform across hospitals," noted Dr. Lyman. "Our analysis of almost one million elective orthopedic surgeries shows that this is not the case. High-volume centers, which have extensive orthopedic surgical experience, offer high-quality surgeries and accompanying recovery periods for patients."

With this new information, the authors hope that patients will be able to make informed decisions about where to go for orthopedic surgery such as elective hip replacement, one of the most common operations in the country.

Insights into the treatment of rotator cuff tears, based on research at Hospital for Special Surgery, a high-volume center for sports medicine, will also be presented at the meeting. In particular, five-year long-term results of rotator cuff repairs and research on how platelet-rich plasma affects rotator cuff healing will be discussed.

In other studies being presented at AAOS, HSS investigators found that time spent in the operating room--a crucial issue in hospitals around the country--is significantly longer for obese patients than for normal weight patients. Researchers will also discuss how hip injuries (and subsequent surgeries) may affect return-to-work decisions of professional dancers.