title: Risk for Complication after Total Joint Arthroplasty at a Center of Excellence: The Impact of Patient Travel Distance.
abstract: Healthcare reorganization and bundled payment schemes have resulted in increased patient travel distances in orthopedics. Travel distance has been previously associated with increased complication risk but has yet to be studied in orthopedics. We analyzed the impact of patient travel distance on short-term complications. We reviewed 38,887 TJAs performed between 2008 and 2011 and identified 1606 complications in 1110 procedures. There was no significant association between complication risk and patient travel distance. Complication risk was associated with age, ASA class, Medicare and Medicaid status (P<0.0001 for all). Regional centers of excellence appear to be a viable model in healthcare reorganization however continued attention should be paid to attenuating the individual patient factors associated with complication at these institutions.
authors: Hospital for Special Surgery, New York, New York.
authors: Benedict U
authors: BU
authors: Nwachukwu
authors: Washington University School of Medicine, St. Louis, Missouri.
authors: Christopher J
authors: CJ
authors: Dy
authors: Hospital for Special Surgery, New York, New York.
authors: Jayme C
authors: JC
authors: Burket
authors: Hospital for Special Surgery, New York, New York.
authors: Douglas E
authors: DE
authors: Padgett
authors: Hospital for Special Surgery, New York, New York.
authors: Stephen
authors: S
authors: Lyman
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000191:economics; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000191:economics; D003695:Delivery of Health Care / Q000191:economics; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008484:Medicaid; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D016017:Odds Ratio; D009985:Orthopedics / Q000191:economics; D011183:Postoperative Complications; D011446:Prospective Studies; D012051:Reimbursement Mechanisms; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States
keywords: complication; revision; socioeconomics; total hip arthroplasty; total knee arthroplasty; travel distance