The higher the hospital's surgical volume, the lower the rate of its post-op complications among total joint replacement patients, according to a study comparing arthroplasty outcome measures between low- and high-volume hospitals.

The research, who published their findings in the journal Arthritis & Rheumatism, analyzed data on nearly 30,000 patients who underwent elective total hip or total knee replacement surgery in Pennsylvania in 2002. Hospitals were categorized based on the number of surgical procedures they perform annually, with "low-volume hospitals" defined as those performing less than 25 surgeries, 26 to 100 surgeries or 101-200 surgeries a year, and "high-volume hospitals" defined as those with more than 200 surgeries performed annually.

Among the patient pool studied, which had a mean age of 69, those who had total hip replacements performed at low-volume facilities were more likely to develop a pulmonary embolism with 30 days of surgery and more likely to die within 1 year of surgery than those who had the procedure done at a high-volume hospital. In the total knee group, elderly patients having the surgery performed at low-volume hospitals also had significantly higher rates of 1-year mortality than those being treated at high-volume hospitals.

"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," says lead author Jasvinder Singh, MD, MPH of the University of Alabama, in a press release announcing the findings.

The researchers believe perioperative and post-operative processes and procedures may play a role in the higher complication rates at low-volume facilities, and therefore low-volume hospitals may be able to improve their outcomes by modifying their processes. For example, they cite the timing of anti-clotting therapy and the types of medications and devices used to prevent post-operative deep vein thrombosis as variable factors that can impact surgical outcomes.

What is your facility's policy for preventing deep vein thrombosis? Discuss here.

Irene Tsikitas