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High-Volume Hospitals Improve Orthopedic Outcomes

February 18, 2011

Hospital for Special Surgery research on platelet-rich plasma and obesity also highlighted at AAOS Meeting

Patients who undergo elective orthopedic surgeries at high-volume, regional hospitals have better surgical outcomes and experience fewer complications than those who undergo those surgeries at local hospitals, according to research being presented by Hospital for Special Surgery investigators at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

These “regionalizers”"”patients who travel to a regional, high-volume hospital””also tend to be younger, white, male and have private insurance, according to the research from Hospital for Special Surgery (HSS) in New York, which performs the highest number of joint replacements in the country.

Analyzing more than 974,000 patients who received elective total shoulder or total hip arthroplasty over two studies, the researchers found significant differences in rates of infection and death during hospitalization, depending on whether patients had surgery at a local hospital or at a regional high-volume hospital.

The studies, which collected information from statewide hospitalization databases in 13 U.S. states, were led by Stephen Lyman, Ph.D., director of Epidemiology and Biostatistics, and Robert Marx, M.D., an orthopedic surgeon in the Sports Medicine and Shoulder Service, both from Hospital for Special Surgery.

“Compared to local hospitals, high-volume regional centers are associated with improved outcomes and decreased post-operative complications,” said Dr. Marx. “Our analyses showed that regionalizers are less likely to have infections or complications.”

Patients who traveled to regional centers for surgery””and thus had better outcomes””were disproportionately younger, male and white. These results were statistically significant, even after adjusting for factors like age, sex, race, year of surgery and hospital volume.

“More and more, patients consider healthcare to be a commodity. They see medical centers as interchangeable, and believe that surgical outcomes are uniform across hospitals,” noted Dr. Lyman. “Our analysis of almost one million elective orthopedic surgeries shows that this is not the case. High-volume centers, which have extensive orthopedic surgical experience, offer high-quality surgeries and accompanying recovery periods for patients.”

With this new information, the authors hope that patients will be able to make informed decisions about where to go for orthopedic surgery such as elective hip replacement, one of the most common operations in the country.

Insights into the treatment of rotator cuff tears, based on research at Hospital for Special Surgery, a high-volume center for sports medicine, will also be presented at the meeting. In particular, five-year long-term results of rotator cuff repairs and research on how platelet-rich plasma affects rotator cuff healing will be discussed.

In other studies being presented at AAOS, HSS investigators found that time spent in the operating room””a crucial issue in hospitals around the country””is significantly longer for obese patients than for normal weight patients. Researchers will also discuss how hip injuries (and subsequent surgeries) may affect return-to-work decisions of professional dancers.

Highlights of presentations by Hospital for Special Surgery scientists include:

Regionalization of Elective Total Shoulder Arthroplasty (Podium 083)
Wednesday, Feb. 16, 8:54 a.m. ““ 9:00 a.m. San Diego Convention Center, Room 6D.

An analysis of 40,937 patients who underwent elective total shoulder arthroplasty found that patients who chose to travel to a regional, high-volume center for the operation were substantially less likely to experience post-operative surgical complications than patients who had the operation at a local hospital.

Regionalization of Elective Total Knee Arthroplasty (Podium 287)
Thursday, Feb. 17, 8:06 a.m. ““ 8:12 a.m. San Diego Convention Center, Room 6B.

An analysis of 933,381 patients who underwent elective total knee arthroplasty found that patients who chose to travel to a regional, high-volume center for the operation were substantially less likely to experience complications and infections, or to die during hospitalization, than patients who had the operation at a local hospital.

The Effect of Platelet-Rich Fibrin Matrix on Rotator Cuff Tendon Healing (Paper 577)
Friday, Feb. 18, 8:48 a.m. ““ 8:54 a.m. San Diego Convention Center, Room 7.

For years, doctors have used platelet rich plasma (PRP) to promote healing in various surgeries, but a recent study demonstrates that a type of PRP did not improve healing after rotator cuff repair.

The Increased Use of Operating Room Time in Obese Patients During Primary Total Knee Arthroplasty (Paper 595)
Friday, Feb. 18, 11:42 a.m. ““ 11:48 a.m. San Diego Convention Center, Room 6B.

Knee replacement surgery takes far more time to conduct in overweight and obese patients than in normal weight patients, according to recent research at Hospital for Special Surgery. The study has implications for hospital staff scheduling surgeries, operating room utilization and personnel staffing.

Hip Arthroscopy in the Professional Dancer (Paper 642)
Friday, Feb. 18, 11:54 a.m. ““ 12:00 p.m. San Diego Convention Center, Room 7.

A new study has identified factors that predict the ability of a professional dancer to return to professional performance after hip arthroscopy surgery. The results of this study indicated that ballet dancers were significantly less likely to be able to return to work compared with modern dancers or dance theater performers.

Prospective Evaluation of Arthroscopic Rotator Cuff Repairs at 5 Years. ASES Specialty Day
Saturday, Feb. 19, 7:35 a.m. ““ 7:40 a.m. San Diego Convention Center, Room 6A.

For years, doctors have used platelet rich plasma (PRP) to promote healing in various surgeries, but a recent study demonstrates that a type of PRP did not improve healing after rotator cuff repair.

A High Incidence of Athletic Pubalgia in Professional Athletes with Symptomatic FAI. AOSSM Specialty Day
Saturday, Feb. 19, 8:30 a.m. ““ 8:37 a.m. San Diego Convention Center, Ballroom 20A.

Sports hernias are commonly found in individuals with a mechanical disorder of the hip and can be resolved with surgery to fix the hip disorder alone in some cases, according to a recent study.

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