| Title |
Are TKAs Performed in High-volume Hospitals Less Likely to Undergo Revision Than TKAs Performed in Low-volume Hospitals?
|
|---|---|
| Published in |
Clinical Orthopaedics & Related Research, August 2017
|
| DOI | 10.1007/s11999-017-5463-x |
| Pubmed ID | |
| Authors |
Elke Jeschke, Mustafa Citak, Christian Günster, Andreas Matthias Halder, Karl-Dieter Heller, Jürgen Malzahn, Fritz Uwe Niethard, Peter Schräder, Josef Zacher, Thorsten Gehrke |
| Abstract |
High-volume hospitals have achieved better outcomes for THAs and unicompartmental knee arthroplasties (UKAs). However, few studies have analyzed implant survival after primary TKA in high-volume centers. Is the risk of revision surgery higher when receiving a TKA in a low-volume hospital than in a high-volume hospital? Using nationwide billing data of the largest German healthcare insurer for inpatient hospital treatment, we identified 45,165 TKAs in 44,465 patients insured by Allgemeine Ortskrankenkasse who had undergone knee replacement surgery between January 2012 and December 2012. Revision rates were calculated at 1 and 2 years in all knees. The hospital volume was calculated using volume quintiles of the number of all knee arthroplasties performed in each center. We used multiple logistic regression to model the odds of revision surgery as a function of hospital volume. Age, sex, 31 comorbidities, and variables for socioeconomic status were included as independent variables in the model. After controlling for socioeconomic factors, patient age, sex, and comorbidities, we found that having surgery in a high-volume hospital was associated with a decreased risk of having revision TKA within 2 years of the index procedure. The odds ratio for the 2-year revision was 1.6 (95% CI, 1.4-2.0; p < 0.001) for an annual hospital volume of 56 or fewer cases, 1.5 (95% CI, 1.3-1.7; p < 0.001) for 57 to 93 cases, 1.2 (95% CI, 1.0-1.3; p = 0.039) for 94 to 144 cases, and 1.1 (95% CI, 0.9-1.2; p = 0.319) for 145 to 251 cases compared with a hospital volume of 252 or more cases. We found a clear association of higher risk for revision surgery when undergoing a TKA in a hospital where less than 145 arthroplasties per year were performed. The study results could help practitioners to guide potential patients in hospitals that perform more TKAs to reduce the overall revision and complication rates. Furthermore, this study underscores the importance of a minimum hospital threshold of arthroplasty cases per year to get permission to perform an arthroplasty. Level III, therapeutic study. |
X Demographics
The data shown below were collected from the profiles of 22 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 6 | 27% |
| United Kingdom | 3 | 14% |
| Australia | 1 | 5% |
| Spain | 1 | 5% |
| Colombia | 1 | 5% |
| India | 1 | 5% |
| Canada | 1 | 5% |
| Nigeria | 1 | 5% |
| Unknown | 7 | 32% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 11 | 50% |
| Practitioners (doctors, other healthcare professionals) | 6 | 27% |
| Scientists | 4 | 18% |
| Science communicators (journalists, bloggers, editors) | 1 | 5% |
Mendeley readers
The data shown below were compiled from readership statistics for 66 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 66 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Ph. D. Student | 10 | 15% |
| Other | 8 | 12% |
| Researcher | 8 | 12% |
| Student > Doctoral Student | 6 | 9% |
| Student > Master | 5 | 8% |
| Other | 10 | 15% |
| Unknown | 19 | 29% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 29 | 44% |
| Business, Management and Accounting | 4 | 6% |
| Nursing and Health Professions | 3 | 5% |
| Pharmacology, Toxicology and Pharmaceutical Science | 2 | 3% |
| Computer Science | 2 | 3% |
| Other | 4 | 6% |
| Unknown | 22 | 33% |
Attention Score in Context
This research output has an Altmetric Attention Score of 16. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 19 August 2017.
All research outputs
#2,337,041
of 25,756,911 outputs
Outputs from Clinical Orthopaedics & Related Research
#339
of 7,324 outputs
Outputs of similar age
#42,992
of 329,210 outputs
Outputs of similar age from Clinical Orthopaedics & Related Research
#5
of 68 outputs
Altmetric has tracked 25,756,911 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 90th percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 7,324 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 5.8. This one has done particularly well, scoring higher than 95% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 329,210 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 86% of its contemporaries.
We're also able to compare this research output to 68 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 92% of its contemporaries.