The effect of hospital volume on length of stay, re-admissions, and complications of total hip arthroplasty.
OBJECTIVE
Hospital volume has been suggested to be one of the best indicators of adverse orthopedic events in patients undergoing THR surgery. We therefore evaluated the effect of hospital volume on the length of stay, re-admissions, and complications of THR at the population level in Finland.


METHODS
30,266 THRs performed for primary osteoarthritis were identified from the Hospital Discharge Register. Hospitals were classified into 4 groups according to the number of THRs performed on an annual basis over the whole study period: 1-50 (group 1), 51-150 (group 2), 151-300 (group 3), and > 300 (group 4).


RESULTS
In 2005, the length of the period of surgical treatment was 5.5 days in group 4 and 6.8 days in group 1 (the reference group). During the whole study period (1998-2005), the length of surgical treatment period was shorter in group 4 than in group 1 (p < 0.001). The odds ratio for dislocations (0.7, 95% CI: 0.6-0.9) was lower in group 3 than in group 1.


CONCLUSIONS
Hip replacements performed in high-volume hospitals reduce costs by shortening the length of stay, and they may reduce the dislocation rate.
Department of Orthopaedics and Traumatology, Turku University Central Hospital, Finland. keijo.makela@tyks.fi
Keijo T
KT
Mäkelä
Unto
U
Häkkinen
Mikko
M
Peltola
Miika
M
Linna
Heikki
H
Kröger
Ville
V
Remes
D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000592:standards / Q000706:statistics & numerical data; D002983:Clinical Competence; D005387:Finland; D005500:Follow-Up Studies; D006618:Hip Dislocation, Congenital / Q000150:complications / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D015207:Osteoarthritis, Hip / Q000150:complications / Q000601:surgery; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology; D012042:Registries; D012086:Reoperation; D016896:Treatment Outcome