Meaningful thresholds for the volume-outcome relationship in total knee arthroplasty

Sean Wilson, Robert G. Marx, Ting Jung Pan, Leonard Lyman Stephen

研究成果: ジャーナルへの寄稿記事

41 引用 (Scopus)

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Background: Increasing evidence supports the finding that patients undergoing a total knee arthroplasty with high-volume physicians and hospitals achieve better outcomes. Unfortunately, the existing definitions for high-volume surgeons and hospitals are highly variable and entirely arbitrary. The aim of this study was to identify a set of meaningful hospital and surgeon total knee arthroplasty volume thresholds. Methods: Using 289,976 patients undergoing primary total knee arthroplasty from an administrative database, we applied stratum-specific likelihood ratio (SSLR) analysis of a receiver operating characteristic (ROC) curve to generate sets of volume thresholds most predictive of adverse outcomes. The outcomes considered for surgeon volume included 90-day complication and 2-year revision. For hospital volume, we considered 90-day complications and 90-day mortality. Results: SSLR analysis of the ROC curves for 90-day complication and 2-year revision rates by surgeon volume identified four volume categories: 0 to 12, 13 to 59, 60 to 145, and >146 total knee arthroplasties per year. Complication rates decreased significantly (p< 0.05) in progressively higher-volume categories. Revision rates followed a similar pattern, but did not decrease between surgeons performing 60 to 145 arthroplasties per year and those performing >146 arthroplasties per year. SSLR analysis of 90 day complication and 90-day mortality rates by hospital volume also identified four volume categories: 0 to 89, 90 to 235, 236 to 644, and >645 total knee arthroplasties per year. Complication rates decreased significantly (p < 0.05) in progressively higher-volume categories, but the rates did not decrease between hospitals performing 236 to 644 arthroplasties per year and those performing >645 arthroplasties per year. Mortality rates for hospitals with >645 total knee arthroplasties per year were significantly lower (p < 0.05) than those below the threshold. Conclusions: Our study supports the use of SSLR analysis of ROC curves for risk-based volume stratification in total knee arthroplasty volume-outcomes research. SSLR analysis established meaningful volume definitions for low, medium, high, and very high-volume total knee arthroplasty surgeons and hospitals. This should help patients, surgeons, hospitals, and policymakers to make decisions with regard to the optimal delivery of total knee arthroplasty. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

元の言語英語
ページ(範囲)1683-1690
ページ数8
ジャーナルJournal of Bone and Joint Surgery - American Volume
98
発行部数20
DOI
出版物ステータス出版済み - 1 1 2016

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Knee Replacement Arthroplasties
High-Volume Hospitals
ROC Curve
Arthroplasty
Mortality
Surgeons
Outcome Assessment (Health Care)
Databases
Physicians

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

これを引用

Meaningful thresholds for the volume-outcome relationship in total knee arthroplasty. / Wilson, Sean; Marx, Robert G.; Pan, Ting Jung; Lyman Stephen, Leonard.

:: Journal of Bone and Joint Surgery - American Volume, 巻 98, 番号 20, 01.01.2016, p. 1683-1690.

研究成果: ジャーナルへの寄稿記事

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