title: Limited Hospital Variation in the Use and Yield of CT for Pulmonary Embolism in Patients Undergoing Total Hip or Total Knee Replacement Surgery.
abstract: Purpose To evaluate the variation among U.S. hospitals in overall use and yield of in-hospital computed tomographic (CT) pulmonary angiography (PA) in patients undergoing total hip replacement (THR) or total knee replacement (TKR) surgery. Materials and Methods Patients in the Premier Research Database who underwent elective TKR or THR between 2007 and 2011 were enrolled in this HIPAA-compliant, institutional review board-approved retrospective observational study. The informed consent requirement was waived. Hospitals were categorized into low, medium, and high tertiles of CT PA use to compare baseline patient- and hospital-level characteristics and pulmonary embolism (PE) positivity rates. To further investigate between-hospital variation in CT PA use, a hierarchical logistic regression model that included hospital-specific random effects and fixed patient- and hospital-level effects was used. The intraclass correlation coefficient (ICC) was used to measure the amount of variability in CT PA use attributable to between-hospital variation. Results The cohort included 205 198 patients discharged from 178 hospitals (median of 734.5 patients discharged per hospital; interquartile range, 316-1461 patients) with 3647 CT PA studies (1.8%). The crude frequency of CT PA scans among the hospitals ranged from 0% to 6.2% (median, 1.6%); more than 90% of the hospitals performed CT PA in less than 3% of their patients. The mean hospital-level PE positivity rate was 12.3% (median, 9.1%); there was no significant difference in PE positivity rate across low through high CT PA use tertiles (11.3%, 11.9%, 12.9%, P = .37). After adjustment for hospital- and patient-level factors, the remaining amount of interhospital variation was relatively low (ICC, 9.0%). Conclusion Limited interhospital variation in use and yield of in-hospital CT PA was observed among patients undergoing TKR or THR in the United States.©RSNA, 2016 Online supplemental material is available for this article.
authors.affiliation: From the Applied Imaging Science Laboratory, Department of Radiology (K.K.K., F.J.R.), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., B.T.B., J.L., E.P.), and Department of Orthopedics (L.D.H.), Brigham and Women's Hospital & Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120; Department of Radiology, Juntendo University, Tokyo, Japan (K.K.K., S.A.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Mass (B.T.B.); Department of Biostatistics, Harvard University, Boston, Mass (J.G., T.C.); and Department of Radiology, University of Tokyo, Tokyo, Japan (K.O.).
authors.forename: Kanako K
authors.initials: KK
authors.lastname: Kumamaru
authors.affiliation: From the Applied Imaging Science Laboratory, Department of Radiology (K.K.K., F.J.R.), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., B.T.B., J.L., E.P.), and Department of Orthopedics (L.D.H.), Brigham and Women's Hospital & Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120; Department of Radiology, Juntendo University, Tokyo, Japan (K.K.K., S.A.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Mass (B.T.B.); Department of Biostatistics, Harvard University, Boston, Mass (J.G., T.C.); and Department of Radiology, University of Tokyo, Tokyo, Japan (K.O.).
authors.forename: Hiraku
authors.initials: H
authors.lastname: Kumamaru
authors.affiliation: From the Applied Imaging Science Laboratory, Department of Radiology (K.K.K., F.J.R.), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., B.T.B., J.L., E.P.), and Department of Orthopedics (L.D.H.), Brigham and Women's Hospital & Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120; Department of Radiology, Juntendo University, Tokyo, Japan (K.K.K., S.A.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Mass (B.T.B.); Department of Biostatistics, Harvard University, Boston, Mass (J.G., T.C.); and Department of Radiology, University of Tokyo, Tokyo, Japan (K.O.).
authors.forename: Brian T
authors.initials: BT
authors.lastname: Bateman
authors.affiliation: From the Applied Imaging Science Laboratory, Department of Radiology (K.K.K., F.J.R.), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., B.T.B., J.L., E.P.), and Department of Orthopedics (L.D.H.), Brigham and Women's Hospital & Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120; Department of Radiology, Juntendo University, Tokyo, Japan (K.K.K., S.A.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Mass (B.T.B.); Department of Biostatistics, Harvard University, Boston, Mass (J.G., T.C.); and Department of Radiology, University of Tokyo, Tokyo, Japan (K.O.).
authors.forename: Jessica
authors.initials: J
authors.lastname: Gronsbell
authors.affiliation: From the Applied Imaging Science Laboratory, Department of Radiology (K.K.K., F.J.R.), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., B.T.B., J.L., E.P.), and Department of Orthopedics (L.D.H.), Brigham and Women's Hospital & Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120; Department of Radiology, Juntendo University, Tokyo, Japan (K.K.K., S.A.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Mass (B.T.B.); Department of Biostatistics, Harvard University, Boston, Mass (J.G., T.C.); and Department of Radiology, University of Tokyo, Tokyo, Japan (K.O.).
authors.forename: Tianxi
authors.initials: T
authors.lastname: Cai
authors.affiliation: From the Applied Imaging Science Laboratory, Department of Radiology (K.K.K., F.J.R.), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., B.T.B., J.L., E.P.), and Department of Orthopedics (L.D.H.), Brigham and Women's Hospital & Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120; Department of Radiology, Juntendo University, Tokyo, Japan (K.K.K., S.A.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Mass (B.T.B.); Department of Biostatistics, Harvard University, Boston, Mass (J.G., T.C.); and Department of Radiology, University of Tokyo, Tokyo, Japan (K.O.).
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.affiliation: From the Applied Imaging Science Laboratory, Department of Radiology (K.K.K., F.J.R.), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., B.T.B., J.L., E.P.), and Department of Orthopedics (L.D.H.), Brigham and Women's Hospital & Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120; Department of Radiology, Juntendo University, Tokyo, Japan (K.K.K., S.A.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Mass (B.T.B.); Department of Biostatistics, Harvard University, Boston, Mass (J.G., T.C.); and Department of Radiology, University of Tokyo, Tokyo, Japan (K.O.).
authors.forename: Laurence D
authors.initials: LD
authors.lastname: Higgins
authors.affiliation: From the Applied Imaging Science Laboratory, Department of Radiology (K.K.K., F.J.R.), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., B.T.B., J.L., E.P.), and Department of Orthopedics (L.D.H.), Brigham and Women's Hospital & Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120; Department of Radiology, Juntendo University, Tokyo, Japan (K.K.K., S.A.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Mass (B.T.B.); Department of Biostatistics, Harvard University, Boston, Mass (J.G., T.C.); and Department of Radiology, University of Tokyo, Tokyo, Japan (K.O.).
authors.forename: Shigeki
authors.initials: S
authors.lastname: Aoki
authors.affiliation: From the Applied Imaging Science Laboratory, Department of Radiology (K.K.K., F.J.R.), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., B.T.B., J.L., E.P.), and Department of Orthopedics (L.D.H.), Brigham and Women's Hospital & Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120; Department of Radiology, Juntendo University, Tokyo, Japan (K.K.K., S.A.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Mass (B.T.B.); Department of Biostatistics, Harvard University, Boston, Mass (J.G., T.C.); and Department of Radiology, University of Tokyo, Tokyo, Japan (K.O.).
authors.forename: Kuni
authors.initials: K
authors.lastname: Ohtomo
authors.affiliation: From the Applied Imaging Science Laboratory, Department of Radiology (K.K.K., F.J.R.), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., B.T.B., J.L., E.P.), and Department of Orthopedics (L.D.H.), Brigham and Women's Hospital & Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120; Department of Radiology, Juntendo University, Tokyo, Japan (K.K.K., S.A.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Mass (B.T.B.); Department of Biostatistics, Harvard University, Boston, Mass (J.G., T.C.); and Department of Radiology, University of Tokyo, Tokyo, Japan (K.O.).
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Rybicki
authors.affiliation: From the Applied Imaging Science Laboratory, Department of Radiology (K.K.K., F.J.R.), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (H.K., B.T.B., J.L., E.P.), and Department of Orthopedics (L.D.H.), Brigham and Women's Hospital & Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120; Department of Radiology, Juntendo University, Tokyo, Japan (K.K.K., S.A.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Mass (B.T.B.); Department of Biostatistics, Harvard University, Boston, Mass (J.G., T.C.); and Department of Radiology, University of Tokyo, Tokyo, Japan (K.O.).
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Patorno
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014481:United States