Larger hospitals and those performing a high number of hip and knee surgeries have significantly lower complication rates and readmissions than other hospitals, per a recent study in The Journal of Bone & Joint Surgery.1
The study looked at 900,000 surgeries of total hip and total knee replacements and found that hospitals in the top 10% of the lowest rates of complications and readmissions had a 6% percent adverse outcome rate. Hospitals in the bottom 10% had an adverse outcome rate of 20%.
Patients overall were twice as likely to suffer an adverse outcome after discharge than while they are still in the hospital. Forty percent of the hospital readmissions occurred 31 or more days after discharge. The study was led by Donald Fry, MD, executive vice president for clinical outcomes management with MPA Healthcare Solutions in Chicago, and adjunct professor of surgery at Northwestern University Feinberg School of Medicine, who says the results indicate a need for improvement among the poor-performing hospitals, especially with the new bundled payment reimbursement system for these procedures.
Fry and his colleagues identified these common characteristics of suboptimal hospitals:
- No consideration of early implementation of non-steroidal anti-inflammatory medications.
- Narcotics given as needed (instead of on a schedule) and commonly delayed while patient is experiencing severe pain.
- Narcotics given in the postoperative period with impaired mental function and an increased risk for falls, which may lead to damage of the new total joint, fractures, and even blunt head trauma.
- Sustained narcotic administration increases the risk of pneumonia, constipation, abdominal distention, nausea, and vomiting.
- Fry DE, Pine M, Nedza SM, et al. Risk-Adjusted Hospital Outcomes in Medicare Total Joint Replacement Surgical Procedures. The Journal of Bone & Joint Surgery 2017;99:10-18.