title: Hospital volume affects outcome after total knee arthroplasty.
abstract: OBJECTIVE
  The influence of hospital volume on the outcome of total knee joint replacement surgery is controversial. We evaluated nationwide data on the effect of hospital volume on length of stay, re-admission, revision, manipulation under anesthesia (MUA), and discharge disposition for total knee replacement (TKR) in Finland.
  
  
  METHODS
  59,696 TKRs for primary osteoarthritis performed between 1998 and 2010 were identified from the Finnish Hospital Discharge Register and the Finnish Arthroplasty Register. Hospitals were classified into 4 groups according to the number of primary and revision knee arthroplasties performed on an annual basis throughout the study period: 1-99 (group 1), 100-249 (group 2), 250-449 (group 3), and ≥ 450 (group 4). The association between hospital procedure volume and length of stay (LOS), length of uninterrupted institutional care (LUIC), re-admissions, revisions, MUA, and discharge disposition were analyzed.
  
  
  RESULTS
  The greater the volume of the hospital, the shorter was the average LOS and LUIC. Smaller hospital volume was not unambiguously associated with increased revision, re-admission, or MUA rates. The smaller the annual hospital volume, the more often patients were discharged home.
  
  
  CONCLUSIONS
  LOS and LUIC ought to be shortened in lower-volume hospitals. There is potential for a reduction in length of stay in extended institutional care facilities.
authors.affiliation: Department of Orthopedics and Traumatology, Central Finland Hospital, Jyväskylä;
authors.forename: Konsta J
authors.initials: KJ
authors.lastname: Pamilo
authors.forename: Mikko
authors.initials: M
authors.lastname: Peltola
authors.forename: Juha
authors.initials: J
authors.lastname: Paloneva
authors.forename: Keijo
authors.initials: K
authors.lastname: Mäkelä
authors.forename: Unto
authors.initials: U
authors.lastname: Häkkinen
authors.forename: Ville
authors.initials: V
authors.lastname: Remes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008349:Manipulation, Orthopedic / Q000706:statistics & numerical data; D008875:Middle Aged; D016017:Odds Ratio; D020370:Osteoarthritis, Knee / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D012042:Registries; D012044:Regression Analysis; D012086:Reoperation / Q000706:statistics & numerical data