Geographical Variation in Outcomes of Primary Hip and Knee Replacement

Key Points Question Are hospital organizational factors, surgical factors, and patient factors associated with patient outcomes and National Health Service costs for total hip and knee replacement? Findings This cohort study of more than 383 000 patients in 207 health areas in England identified significant health area–level variation in patient outcomes for total hip and knee replacement surgery. Geographical variation was associated with better outcomes for surgical procedures in private and high-volume hospitals as well as for operations performed by more experienced surgeons with a higher volume of operations per year. Meaning Findings are informative for commissioners in monitoring variations in surgical outcomes and for patients deciding where to undergo surgery.

[1]  A. Rangan,et al.  Impact of a national enhanced recovery after surgery programme on patient outcomes of primary total knee replacement: an interrupted time series analysis from "The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man". , 2019, Osteoarthritis and cartilage.

[2]  S. Gibbons,et al.  Does competition from private surgical centres improve public hospitals' performance? Evidence from the English National Health Service , 2018, Journal of Public Economics.

[3]  F. Picard,et al.  Minimally invasive total knee replacement: techniques and results , 2018, European Journal of Orthopaedic Surgery & Traumatology.

[4]  A. Silman,et al.  Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: evidence from linked primary care and NHS hospital records from 1997 to 2014 , 2018, BMJ Open.

[5]  Julie Bynum,et al.  Hospital Competition, Quality, and Expenditures in the U.S. Medicare Population , 2016 .

[6]  N. Taylor,et al.  Early mobilization of patients who have had a hip or knee joint replacement reduces length of stay in hospital: a systematic review , 2015, Clinical rehabilitation.

[7]  C. Cooper,et al.  The effect of body mass index on the risk of post-operative complications during the 6 months following total hip replacement or total knee replacement surgery. , 2014, Osteoarthritis and cartilage.

[8]  P. Austin,et al.  Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study , 2014, BMJ : British Medical Journal.

[9]  A. Burston,et al.  Involving Patients in Research: Considering Good Practice , 2013, Musculoskeletal care.

[10]  Peter McCulloch,et al.  Understanding regional variation in the use of surgery , 2014 .

[11]  C. Cooper,et al.  The association of patient characteristics and surgical variables on symptoms of pain and function over 5 years following primary hip-replacement surgery: a prospective cohort study , 2013, BMJ Open.

[12]  C. Cooper,et al.  Pre-operative expectation predicts 12-month post-operative outcome among patients undergoing primary total hip replacement in European orthopaedic centres. , 2010, Osteoarthritis and cartilage.

[13]  N. Welton,et al.  Equity in access to total joint replacement of the hip and knee in England: cross sectional study , 2010, BMJ : British Medical Journal.

[14]  F. Haddad,et al.  Major elective joint replacement surgery: socioeconomic variations in surgical risk, postoperative morbidity and length of stay. , 2010, Journal of evaluation in clinical practice.

[15]  James G Wright,et al.  Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. , 2008, Canadian journal of surgery. Journal canadien de chirurgie.

[16]  J. Farrar,et al.  Identifying important outcome domains for chronic pain clinical trials: An IMMPACT survey of people with pain , 2008, PAIN®.

[17]  H. K. Walker,et al.  Medical Management of the Surgical Patient: Surgical Procedures and their Complications , 2006 .

[18]  M. Lubin,et al.  Medical management of the surgical patient : a textbook of perioperative medicine , 2006 .

[19]  Edward C. Jones,et al.  Measuring improvement following total hip and knee arthroplasty using patient-based measures of outcome. , 2005, The Journal of bone and joint surgery. American volume.

[20]  D C Voaklander,et al.  The effect of age on pain, function, and quality of life after total hip and knee arthroplasty. , 2001, Archives of internal medicine.

[21]  A. Astrup,et al.  Obesity : Preventing and managing the global epidemic , 2000 .

[22]  J. Myles,et al.  Determinants of 6-12 month postoperative functional status and pain after elective total hip replacement. , 1997, International journal for quality in health care : journal of the International Society for Quality in Health Care.