Anna Mealy and Jan Sorensen*
Department of Health, Healthcare Outcomes Research Centre (HORC), Royal College of Surgeons in Ireland, IrelandFulltext PDF
Background: Quality and experience with providing specialized surgical treatment are related. The objective of this study was to explore to what extent quality as indicated by discharge destination, the length of stay and risk of 30-day readmission are associated with the volume of hip replacement procedures in Irish public hospitals.
Methods: Data on hospital discharges with elective hip joint replacement were obtained for 2011- 2016. Multivariate regression models assessed the variation in discharge destination, length of stay and 30-day readmission in public hospitals with high and low (less than 35 procedures annually) volume of patients. Sensitivity analysis tested the robustness of the results by including only patients with total hip joint replacement, only patients with arthropathy as the primary diagnosis, and patients without any recorded comorbidity.
Results: The case-mix of patients at low volume hospitals was different in gender, mean age, revision and comorbidity. After adjustment for these factors low volume hospitals appeared to discharge more patients to other hospitals or nursing homes, had longer length of stay and higher rates of 30-day readmission. These findings were robust when patients with partial or revision procedures, non-arthropathy diagnosis and known comorbidity were excluded.
Conclusion: Low volume hospitals appear to provide hip joint replacement treatments with poorer outcomes than high volume hospitals after adjusting for potentially more complex case-mix of patients.
Hip joint replacement; Volume of care; Length of stay; Readmission
Mealy A, Sorensen J. Elective Hip Arthroplasty: Are Discharge Destination, Length of Stay and Readmissions Related with Patient Volume?Open J Public Health. 2019; 1(1): 1003.