DO HIGH-VOLUME ORTHOPEDIC SURGEONS HAVE LOWER REVISION RATE THAN LOW-VOLUME SURGEONS? A MEDICARE DATABASE ANALYSIS
Author(s)
Holy CE1, Chitnis A1, Wei D2, Lerner J3
1Johnson & Johnson, New Brunswick, NJ, USA, 2Johnson & Johnson Co., New Brunswick, NJ, USA, 3DePuy Synthes, Inc., Raynham, MA, USA
OBJECTIVES: Surgical outcomes are thought to be superior for high- versus low-volume surgeons. This study was designed to evaluate whether an association exists between a surgeon’s own surgical volume and revision rate. METHODS: Patients within Medicare’s Standard Analytic File (SAF) Limited Data Sets who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) from 2012 to 2014 were identified using Diagnosis-related Groups (DRGs) 469-470 and International Classification of Disease 9th edition procedure codes (ICD-9-PCS) 81.51 or 81.52 for THA and 81.54 for TKA. Patients who died within 12 months of index were excluded. Revisions within the 12-month follow-up were identified (THA revision: ICD-9-PC 81.53, 00.70, 00.71, 00.72, 00.73, and TKA procedure: 00.80, 00.81, 00.83, 00.84, 81.55). Two-year surgery volume and average revision rate per surgeon were calculated. Surgeons with < 10 procedures were excluded. Surgeons were grouped based on revision rates and volume of surgery (surgical volume decile: D_SV, revision rate decile: D_RR). Logistic regression was used to calculate odds of having a High_RR surgeon (top decile RR) as a function of procedure volume. RESULTS: A total of 9,446 and 9,507 TKA and THA surgeons were included. The one-year incidence of revision was 2.51% and 1.77% after THA and TKA, respectively. High_RR surgeons had revision rates ≥ 5.00% and 4.61% for THA and TKA, respectively. The proportion of High_RR in each D_SV decreased significantly as D_SV increased. From the lowest to the highest D_SV, the proportion of High_RR surgeons decreased from 25.3% to 1.81% for hips, and 20.72% to 0.11% for knees. The OR of having a High_RR surgeon in the lowest D_SV versus the highest was 5.50 (95%CI: 4.04-7.63) for hips and 40.92 (95%CI: 18.07-92.67) for knees. CONCLUSIONS: The proportion of surgeons with high revision rates was significantly greater in the lower surgery volume decile vs higher decile.
Conference/Value in Health Info
2017-05, ISPOR 2017, Boston, MA, USA
Value in Health, Vol. 20, No. 5 (May 2017)
Code
PMD108
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Multiple Diseases