title: Early Complications in Hip and Knee Arthroplasties in a Safety Net Hospital vs a University Center.
abstract: BACKGROUND
  Indigent populations face unique challenges that may increase surgical risk and adversely affect the outcomes of hip and knee arthroplasties. This study examines whether there is a difference in early postoperative complications in patients treated in a safety net hospital and in a nearby university center.
  
  
  METHODS
  A retrospective review was undertaken of 533 consecutive hip and knee arthroplasties performed by a single experienced surgeon in a safety net hospital and in a university medical center from 2008 to 2012. Patients were followed for a minimum of 2 years. The primary outcomes evaluated were total complications, deep infections, and reoperations. Statistical comparison of the data from the 2 patient groups was carried out using Fisher exact test.
  
  
  RESULTS
  Despite the lower percentage of index revision procedures in the safety net group (8% vs 20.5%; P = .0003), the incidence of adverse outcomes was higher in this group than in the university group: for total complications, 12.3% vs 4.9% (P = .003); for deep infections, 3.2% vs 0.6% (P = .025); and for reoperations, 7.5% vs 2.6% (P = .009). For primary procedures in particular, differences in the incidences of these outcomes were even more significant.
  
  
  CONCLUSIONS
  In this study, early complications were more frequent in patients who underwent hip and knee arthroplasties in a safety net hospital compared with those who underwent the same procedures in a nearby university center. Future prospective studies are warranted to determine which patient-related or care process-related factors should be optimized to improve arthroplasty outcomes in vulnerable, safety net populations.
authors.affiliation: Institute of Global Orthopaedics and Traumatology, UCSF Department of Orthopaedic Surgery, San Francisco, California.
authors.forename: Harry E
authors.initials: HE
authors.lastname: Jergesen
authors.affiliation: UCSF Department of Orthopaedic Surgery, San Francisco, California.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Yi
mesh_terms: D000046:Academic Medical Centers / Q000592:standards / Q000706:statistics & numerical data*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012086:Reoperation / Q000009:adverse effects / Q000706:statistics & numerical data; D012189:Retrospective Studies; D064876:Safety-net Providers / Q000592:standards / Q000706:statistics & numerical data*; D012495:San Francisco / Q000453:epidemiology
keywords: arthroplasty; postoperative complications; safety net hospitals; socioeconomic; underserved populations; universities