Contribution of hospital characteristics to the volume-outcome relationship: dislocation and infection following total hip replacement surgery.

摘要: Objective Mortality and complication rates after total hip replacement (THR) are inversely associated with the volume of THRs performed at hospitals by individual surgeons. It is not clear, however, why a higher such procedures better outcomes. We evaluated contribution hospital structural characteristics to volume–outcome relationship in THR examining predictors postoperative complications. Methods We analyzed data pertaining 5,211 Medicare patients who underwent primary 1995 or 1996 167 Colorado, Pennsylvania, Ohio. Data were derived from several sources, including Part A B claims, American Board Medical Specialties, survey regarding institution-specific aspects care setting, Hospital Association Annual Survey. Multivariate models constructed determine whether structure surgeon-associated factors may underlie between occurrence perioperative orthopedic adverse events, defined as deep wound infection dislocation within 90 days surgery. Results Of studied, 2.6% experienced an event THR. Sixty-nine percent fewer events occurred where >100 annually, compared ≤25 performed. In univariate analyses, hospital-level reduced (∼50%) risk private (versus public) ownership, membership Council Teaching Hospitals, presence any residency training program, availability dedicated nursing unit, existence operating rooms laminar flow exhaust systems. However, only factor multivariate was use When surgeon added models, it strongest predictor having no appreciable association events. Conclusion Hospital-level independent events. The surgeons most important determinant complications should be considered efforts improve