title: Complications after hip arthroplasty and the association with hospital procedure volume.
abstract: OBJECTIVE
  It has been suggested that a higher procedure volume is associated with less complications after hip arthroplasty. In order to investigate the incidence of serious negative outcomes and a possible association with procedure volume, we performed a retrospective nationwide cohort study on total hip replacements in all Dutch hospitals.
  
  
  METHODS
  All total hip replacements (n = 50,080) that were identified as primary intervention in all general and university medical centers between January 1, 2002 and October 1, 2004 were included. Primary endpoints of follow-up were mortality and complications during admission, and re-admission within 3 months due to complications. Variables that were assessed as potential risk factor were age, sex, duration of (preoperative) admission, specific diagnosis, acute/non-planned admission, co-morbidity, and hospital procedure volume.
  
  
  RESULTS
  Age, sex, and comorbidity were associated with complications and mortality. Additionally, acute admission was a risk factor for mortality but not for complications. There was no linear trend indicating that decreasing volume led to an increasing number of complications, and no statistically sginificant effect for mortality was found.
  
  
  CONCLUSIONS
  After adjustment for several risk factors, we found that the hospitals performing most hip procedures every year had fewer complications during index admission, but that they did not have a lower mortality than groups performing fewer procedures. The lack of a linear trend may be explained by the fact that almost all Dutch hospitals perform a high number of hip arthroplasties each year.
authors: Dutch Health Care Inspectorate, the Hague. lm.d.vries@igz.nl
authors: Laura M
authors: LM
authors: de Vries
authors: Miriam C J M
authors: MC
authors: Sturkenboom
authors: Jan A N
authors: JA
authors: Verhaar
authors: J Herre
authors: JH
authors: Kingma
authors: Bruno H C
authors: BH
authors: Stricker
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000592:standards / Q000706:statistics & numerical data; D002983:Clinical Competence; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors