title: Regional and hospital variance in performance of total hip and knee replacements: a national population-based study.
abstract: BACKGROUND
  This article in the supplement on the Performance, Effectiveness, and Costs of Treatment episodes (PERFECT)-project describes the PERFECT Hip and Knee Replacement Database and its possibilities by evaluating regional and hospital-level differences in length of stay (LOS), costs and complication rates of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in Finland.
  
  
  METHODS
  All hip and knee arthroplasties are recorded in the Finnish Hospital Discharge Register (FHDR) and Finnish Arthroplasty Register (FAR). LOS, length of uninterrupted institutional care (LUIC), complication rates and other parameters of treatment were determined by region and hospital during 1998-2008 based on these.
  
  
  RESULTS
  LOS and LUIC following THA and TKA diminished during the follow-up period. In 1998 average LOS after THA and TKA was 9.9 and 10 days. In 2008, these had shortened to 5.2 and 5.3 days, respectively. There was a 5.0 and 7.5 percentage point difference in revision rate between regions in THAs and TKAs, respectively, performed during 2005-2007 and followed to the end of 2009.
  
  
  CONCLUSIONS
  The Finnish health care registers provide a monitoring system for evaluating hospital- and regional-level differences in THA and TKA. The differences in LOS, LUIC and revision rates between hospitals and regions are considerable.
authors.affiliation: Department of Orthopaedics and Traumatology, Turku University Central Hospital, Turku, Finland. keijo.makela@tyks.fi
authors.forename: Keijo T
authors.initials: KT
authors.lastname: Mäkelä
authors.forename: Mikko
authors.initials: M
authors.lastname: Peltola
authors.forename: Reijo
authors.initials: R
authors.lastname: Sund
authors.forename: Antti
authors.initials: A
authors.lastname: Malmivaara
authors.forename: Unto
authors.initials: U
authors.lastname: Häkkinen
authors.forename: Ville
authors.initials: V
authors.lastname: Remes
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000191:economics / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data; D012042:Registries / Q000706:statistics & numerical data