title: Complications and short-term outcomes associated with total hip arthroplasty in teaching and community hospitals.
abstract: We followed 1,810 consecutive admissions for elective total hip arthroplasty (excluding hip fracture repair and revisions) to 27 Minnesota hospitals in a prospective study to assess the factors associated with better outcomes. Patients were interviewed before surgery and at 6 months, and their medical records were reviewed. The operative complication rate was 6.1%. In general, neither surgeon nor hospital volume had any significant association with the likelihood of operative complications. For the cementless prosthesis group, significantly more operative complications were associated with being in Health Maintenance Organizations or with insurance other than Medicare. General complications were associated positively with a higher caseload per surgeon for patients receiving cemented prostheses. Hospital volume had no significant relationship to the general complication rate. Hospital and surgical volume and most other provider characteristics were not associated with walking and pain outcomes; however, follow-up pain scores for patients with cementless prostheses were lower for board-certified orthopaedists even after adjusting for risk factors.
authors.affiliation: Academic Health Center, Minneapolis, Minnesota, USA.
authors.forename: Roby
authors.initials: R
authors.lastname: Thompson
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
authors.forename: Terry
authors.initials: T
authors.lastname: Gromala
authors.forename: Barbara
authors.initials: B
authors.lastname: McLaughlin
authors.forename: Shannon
authors.initials: S
authors.lastname: Flood
authors.forename: Nora
authors.initials: N
authors.lastname: Morris
authors.forename: Catherine
authors.initials: C
authors.lastname: Borbas
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D001843:Bone Cements; D002983:Clinical Competence; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007348:Insurance, Health; D016015:Logistic Models; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D016526:Workload
chemical_list: D001843:Bone Cements