Variation in Hospital-Level Risk-Standardized Complication Rates Following Elective Primary Total Hip and Knee Arthroplasty
Variation in Hospital-Level Risk-Standardized Complication Rates Following Elective Primary Total Hip and Knee Arthroplasty
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DOI：
10.2106/jbjs.l.01639
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发表时间：
2014-04-16
影响因子：
5.3
通讯作者：
Drye, Elizabeth E.
中科院分区：
文献类型：
--
作者：
Bozic, Kevin J.;Grosso, Laura M.;Drye, Elizabeth E.
工作背景：关于美国医院进行择期全髋关节置换术（THA）和全膝关节置换术（TKA）手术的并发症发生率的变化，我们知之甚少。本研究的目的是使用国家质量论坛（NQF）认可的医院级别的风险标准化并发症发生率来描述的变化，和相关的差距，医院质量的选择性主要THA和TKA程序在美国hospites.Methods：我们进行了一项全国医疗保险收费服务数据的横断面分析。研究队列包括878，098名医疗保险按服务收费的受益人，65岁或以上，他们从2008年到2010年在3479家医院接受了择期THA或TKA。内科和外科并发症都包括在复合指标中。医院特异性并发症发生率是根据医疗保险索赔计算的，使用分层逻辑回归来解释患者的聚集性，并根据年龄、性别和患者合并症进行风险调整。我们确定了医疗补助患者和黑人患者比例较高的医院是否具有较高的风险标准化并发症率。结果：测量的并发症的粗率为3.6%。最常见的并发症是肺炎（0.86%）、肺栓塞（0.75%）和假体周围关节感染或伤口感染（0.67%）。中位风险标准化并发症发生率为3.6%（范围：1.8%-9.0%）。在研究队列中至少有25例THA和TKA患者的医院中，103例（3.6%）比预期更好，75例（2.6%）比预期更差。与最低十分位数的医院（3.4%; 1.7%至6.2%）相比，医疗补助患者比例最高的医院的风险标准化并发症发生率略高，但相似（中位数，3.6%;范围，2.0%至7.1%）。结果是相似的分析，涉及黑人patients.Conclusions的比例：有超过四倍的差异，在美国的医院，择期THA和伊拉进行的风险标准化并发症发生率。虽然医疗补助和黑人患者比例较高的医院与比例较低的医院的比率相似，但仍需要监测结果的差异。这些结果表明，在进行择期THA和伊拉手术的医院中，有机会提高质量。
Background: Little is known about the variation in complication rates among U.S. hospitals that perform elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures. The purpose of this study was to use National Quality Forum (NQF)-endorsed hospital-level risk-standardized complication rates to describe variations in, and disparities related to, hospital quality for elective primary THA and TKA procedures performed in U.S. hospitals.Methods: We conducted a cross-sectional analysis of national Medicare Fee-for-Service data. The study cohort included 878,098 Medicare fee-for-service beneficiaries, sixty-five years or older, who underwent elective THA or TKA from 2008 to 2010 at 3479 hospitals. Both medical and surgical complications were included in the composite measure. Hospital-specific complication rates were calculated from Medicare claims with use of hierarchical logistic regression to account for patient clustering and were risk-adjusted for age, sex, and patient comorbidities. We determined whether hospitals with higher proportions of Medicaid patients and black patients had higher risk-standardized complication rates.Results: The crude rate of measured complications was 3.6%. The most common complications were pneumonia (0.86%), pulmonary embolism (0.75%), and periprosthetic joint infection or wound infection (0.67%). The median risk-standardized complication rate was 3.6% (range, 1.8% to 9.0%). Among hospitals with at least twenty-five THA and TKA patients in the study cohort, 103 (3.6%) were better and seventy-five (2.6%) were worse than expected. Hospitals with the highest proportion of Medicaid patients had slightly higher but similar risk-standardized complication rates (median, 3.6%; range, 2.0% to 7.1%) compared with hospitals in the lowest decile (3.4%; 1.7% to 6.2%). Findings were similar for the analysis involving the proportion of black patients.Conclusions: There was more than a fourfold-difference in risk-standardized complication rates across U.S. hospitals in which elective THA and IRA are performed. Although hospitals with higher proportions of Medicaid and black patients had rates similar to those of hospitals with lower proportions, there is a continued need to monitor for disparities in outcomes. These findings suggest there are opportunities for quality improvement among hospitals in which elective THA and IRA procedures are performed.