Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Joint replacement surgery riskier at hospitals with low surgical volume

07.06.2011
Greater risk of blood clots and mortality following hip or knee arthroplasty

Patients who undergo elective total hip or total knee arthroplasty at hospitals with lower surgical volume had a higher risk of venous thromboembolism and mortality following the procedure. The complications following joint replacement surgery at low-volume sites may be reduced by modifying systems and procedures used before and after surgery according to the findings published today in Arthritis & Rheumatism, a peer-reviewed journal of the American College of Rheumatology (ACR).

The ACR estimates that 27 million Americans over the age of 25 have doctor-diagnosed osteoarthritis and another 1.3 million US adults suffer with rheumatoid arthritis. For patients with end-stage hip and knee arthritis, total hip and knee arthroplasty are highly successful surgical interventions that offer patients significant improvement in pain, function and health-related quality of life. According to the Centers for Disease Control and Prevention (CDC) National Hospital Discharge Survey, roughly 230,000 total hip replacements and 543,000 total knee replacements were performed in the U.S. in 2007.

The current study explored the relationship between hospital procedure volume and surgical outcomes following primary total hip or total knee replacements. "With the large number of elective arthroplasty in the U.S, it is important to understand the impact of peri- and post-operative medical complications on the success of joint replacement surgery," said lead author Jasvinder Singh, MD, MPH of the University of Alabama. "Possible cardiac complications, blood clots, or infections increase patient morbidity and mortality risk, which can lead to higher health care utilization and costs."

Researchers used the Pennsylvania Health Care Cost Containment Council database to identify the number of patients who underwent total hip replacement (n=10,187) and total knee replacement (n=19,418) surgery in 2002 in the state. The mean age of patients in both groups was 69 years, and men comprised 43% of the total hip replacement cohort and 35% of the total knee replacement group. Hospital volume was categorized by less than 25 surgeries, 26-100, 101-200 (low-volume hospitals), and greater than 200 surgeries (high-volume hospitals) performed annually.

The findings show that patients who had primary total hip arthroplasty at low-volume hospitals were more likely to develop a pulmonary embolism (within 30 days of surgery) than those who had surgery at a high-volume hospital. One-year mortality was also higher for patients having total hip replacements at low-volume hospitals.

Researchers found that for total knee arthroplasty, patients age 65 and older had significantly higher odds for one-year mortality when surgeries were performed at low-volume hospitals compared to higher volume hospitals.

The authors theorize that the causes of complications at low-volume hospitals could be connected to hospital procedures and peri- and post-operative care processes. One example cited is differences in the selection of the best medication and device used to prevent blood clots following elective joint replacement surgery. The authors also suggest that the outcome of surgery is impacted by time of initiation and cessation of the clot prevention therapy. Dr. Singh concluded, "Further studies are needed to investigate whether the underlying reasons for poor surgical outcomes at low-volume hospitals are modifiable and which interventions may reduce complications for patients at these facilities."

This study is published in Arthritis & Rheumatism. Media wishing to receive a PDF of the article may contact healthnews@wiley.com.

Full citation: "Hospital Volume and Surgical Outcomes after Elective Hip/Knee Arthroplasty: A Risk Adjusted Analysis of a Large Regional Database." Jasvinder A. Singh, C. Kent Kwoh, Robert M. Boudreau, Gwo-Chin Lee, Said A. Ibrahim.Arthritis & Rheumatism; Published Online: June 7, 2011 (DOI: 10.1002/art.30390). http://doi.wiley.com/10.1002/art.30390.

About the Journal

Arthritis & Rheumatism is an official journal of the American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals (ARHP), a division of the College, and covers all aspects of inflammatory disease. The American College of Rheumatology (www.rheumatology.org) is the professional organization who share a dedication to healing, preventing disability, and curing the more than 100 types of arthritis and related disabling and sometimes fatal disorders of the joints, muscles, and bones. Members include practicing physicians, research scientists, nurses, physical and occupational therapists, psychologists, and social workers. For details, please visit http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1529-0131.

About Wiley-Blackwell

Wiley-Blackwell is the international scientific, technical, medical, and scholarly publishing business of John Wiley & Sons, with strengths in every major academic and professional field and partnerships with many of the world's leading societies. Wiley-Blackwell publishes nearly 1,500 peer-reviewed journals and 1,500+ new books annually in print and online, as well as databases, major reference works and laboratory protocols. For more information, please visit www.wileyblackwell.com or our new online platform, Wiley Online Library (wileyonlinelibrary.com), one of the world's most extensive multidisciplinary collections of online resources, covering life, health, social and physical sciences, and humanities.

Dawn Peters | EurekAlert!
Further information:
http://www.wiley.com

More articles from Studies and Analyses:

nachricht Multi-year study finds 'hotspots' of ammonia over world's major agricultural areas
17.03.2017 | University of Maryland

nachricht Diabetes Drug May Improve Bone Fat-induced Defects of Fracture Healing
17.03.2017 | Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Giant Magnetic Fields in the Universe

Astronomers from Bonn and Tautenburg in Thuringia (Germany) used the 100-m radio telescope at Effelsberg to observe several galaxy clusters. At the edges of these large accumulations of dark matter, stellar systems (galaxies), hot gas, and charged particles, they found magnetic fields that are exceptionally ordered over distances of many million light years. This makes them the most extended magnetic fields in the universe known so far.

The results will be published on March 22 in the journal „Astronomy & Astrophysics“.

Galaxy clusters are the largest gravitationally bound structures in the universe. With a typical extent of about 10 million light years, i.e. 100 times the...

Im Focus: Tracing down linear ubiquitination

Researchers at the Goethe University Frankfurt, together with partners from the University of Tübingen in Germany and Queen Mary University as well as Francis Crick Institute from London (UK) have developed a novel technology to decipher the secret ubiquitin code.

Ubiquitin is a small protein that can be linked to other cellular proteins, thereby controlling and modulating their functions. The attachment occurs in many...

Im Focus: Perovskite edges can be tuned for optoelectronic performance

Layered 2D material improves efficiency for solar cells and LEDs

In the eternal search for next generation high-efficiency solar cells and LEDs, scientists at Los Alamos National Laboratory and their partners are creating...

Im Focus: Polymer-coated silicon nanosheets as alternative to graphene: A perfect team for nanoelectronics

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are less stable. Now researchers at the Technical University of Munich (TUM) have, for the first time ever, produced a composite material combining silicon nanosheets and a polymer that is both UV-resistant and easy to process. This brings the scientists a significant step closer to industrial applications like flexible displays and photosensors.

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are...

Im Focus: Researchers Imitate Molecular Crowding in Cells

Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to simulate these confined natural conditions in artificial vesicles for the first time. As reported in the academic journal Small, the results are offering better insight into the development of nanoreactors and artificial organelles.

Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

International Land Use Symposium ILUS 2017: Call for Abstracts and Registration open

20.03.2017 | Event News

CONNECT 2017: International congress on connective tissue

14.03.2017 | Event News

ICTM Conference: Turbine Construction between Big Data and Additive Manufacturing

07.03.2017 | Event News

 
Latest News

Argon is not the 'dope' for metallic hydrogen

24.03.2017 | Materials Sciences

Astronomers find unexpected, dust-obscured star formation in distant galaxy

24.03.2017 | Physics and Astronomy

Gravitational wave kicks monster black hole out of galactic core

24.03.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>