Outcomes of total joint arthroplasty in academic versus community hospitals.
BACKGROUND
Most joint-replacement surgeries are currently performed in community hospitals. We sought to determine whether the functional outcomes of joint-replacement surgery differ between academic and community hospitals.


METHODS
We surveyed 471 patients for demographic data, Western Ontario McMaster University Osteoarthritis Index (WOMAC) scores and Medical Outcomes Study Short Form 36 (SF-36) scores at baseline and at 3-month and 1-year follow-up. We assessed patient satisfaction at 1 year with a single survey question.


RESULTS
Community hospital patients (n = 269) were significantly older and had greater comorbidity than academic hospital patients (n = 202; p < 0.05). We found no difference in WOMAC scores, SF-36 scores or in patient satisfaction between hospitals at 1-year follow-up (p > 0.05). Adjusted analysis showed that patients undergoing surgery in an academic or community hospitals have the same functional outcomes.


CONCLUSIONS
There is no significant difference in the functional outcomes of joint-replacement surgery between academic and community hospitals. Further work will involve evaluating cost of care differences between these types of hospitals.
Division of Orthopedic Surgery, Toronto Western Hospital and University of Toronto, Toronto, Ont. rajiv.gandhi@uhn.on.ca
Rajiv
R
Gandhi
Peggy
P
Tso
Aileen
A
Davis
Nizar N
NN
Mahomed
D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000379:methods* / Q000534:rehabilitation; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009864:Ontario; D010147:Pain Measurement; D010358:Patient Participation; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011475:Prosthesis Failure; D011787:Quality of Health Care; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012086:Reoperation / Q000706:statistics & numerical data; D018570:Risk Assessment; D012737:Sex Factors; D016896:Treatment Outcome