A comparison of total hip and knee replacement in specialty and general hospitals
A comparison of total hip and knee replacement in specialty and general hospitals
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DOI：
10.2106/jbjs.f.00873
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发表时间：
2007-08-01
影响因子：
5.3
通讯作者：
Rosenthal, Gary E.
中科院分区：
文献类型：
--
作者：
Cram, Peter;Vaughan-Sarrazin, Mary S.;Rosenthal, Gary E.
背景资料：骨科专科医院的出现引起了广泛的争议，但很少有人知道他们提供的护理质量。我们的目的是比较的特点和结果进行重大关节置换术的患者在专业骨科和综合hospital.Methods：我们进行了一项回顾性队列研究的51,788名医疗保险受益人进行全髋关节置换术和99,765人进行全膝关节置换术在38个专业骨科医院和517个综合医院在1999年和2003年之间。我们比较了在专科医院和综合医院接受治疗的患者的人口统计学数据、共病率和社会经济状况。Logistic回归被用来计算调整后的患者特征和医院的程序volume.Results的人口统计数据和比例的主要修订关节置换术的不良后果（死亡或选定的手术并发症）的几率，但在专科医院接受治疗的患者有较少的comorbiliary和居住在更富裕的邮政编码比他们的同行在综合医院在2003年。2003年，专科医院的全髋关节置换术（33例对20例; p = 0.05）和全膝关节置换术（75例对40例; p = 0.006）的平均手术量明显高于综合医院。专科医院的全髋关节置换术（3.0%）和全膝关节置换术（2.1%）的未校正不良结局发生率低于综合医院（6.9%; p < 0.001）。在调整患者特征和手术量后，专科医院的患者发生不良结局的几率明显低于综合医院的患者，（比值比，0.64; 95%置信区间，0.56至0.75; p < 0.001）和翻修关节置换术（优势比，0.49; 95%可信区间，0.36 ~ 0.66; p < 0.001）.结论：根据医疗保险管理数据，在调整患者特征和医院容量后，骨科专科医院比综合医院有更好的患者预后。证据等级：治疗水平III。证据等级的完整描述见作者说明。
Background: The emergence of specialty orthopaedic hospitals has generated widespread controversy, but little is known about the quality of care they deliver. Our objective was to compare the characteristics and outcomes of patients undergoing major joint replacement in specialty orthopaedic and general hospitals.Methods: We conducted a retrospective cohort study of 51,788 Medicare beneficiaries who underwent total hip replacement and 99,765 who underwent total knee replacement in thirty-eight specialty orthopaedic hospitals and 517 general hospitals between 1999 and 2003. We compared demographic data, rates of comorbid illness, and socioeconomic status of patients treated in specialty and general hospitals. Logistic regression was used to calculate the odds of an adverse outcome (death or selected surgical complications) after adjustment for patient characteristics and hospital procedural volume.Results: The demographic data and the ratio of primary to revision arthroplasties were similar, but patients who received care in specialty hospitals had less comorbidity and resided in more affluent zip codes than their counterparts in general hospitals in 2003. Specialty hospitals had significantly greater mean procedural volumes in 2003 than did general hospitals for both total hip replacement (thirty-three compared with twenty procedures; p = 0.05) and total knee replacement (seventy-five compared with forty procedures; p = 0.006). The unadjusted rate of adverse outcomes was lower in specialty hospitals than in general hospitals for total hip replacement (3.0% compared with 6.9%; p < 0.001) and total knee replacement (2.1% compared with 3.9%; p < 0.001). After adjusting for patient characteristics and procedural volume, the odds of adverse outcomes occurring were significantly lower for patients in specialty hospitals than for those in general hospitals for both primary joint replacement (odds ratio, 0.64; 95% confidence interval, 0.56 to 0.75; p < 0.001) and revision joint replacement (odds ratio, 0.49; 95% confidence interval, 0.36 to 0.66; p < 0.001).Conclusions: After adjustment for patient characteristics and hospital volume, the specialty orthopaedic hospitals had better patient outcomes, as measured by Medicare administrative data, than did the general hospitals.Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.