8 trends in major orthopedic surgery outcomes in the United States

Written by Laura Dyrda | July 31, 2014 | Print  |

The Journal of Bone and Joint Surgery recently published an article examining the incidence and in-hospital outcomes of elective major orthopedic surgery for patients older than 80.

The authors examined data from the Nationwide Inpatient Sample on patients who underwent spinal fusion, total hip arthroplasty or total knee arthroplasty from 2000 to 2009. All the patients were 80 years old or older.


Here are eight trends on major orthopedic surgery in the United States:


1. The number of patients undergoing spinal fusion, total hip arthroplasty and total knee arthroplasty increased from 2000 to 2009:


•    Spinal fusion: 40 per 100,000 to 102 per 100,000 annually
•    Total hip arthroplasty: 181 per 100,000 to 257 per 100,000 annually
•    Total knee arthroplasty: 300 per 100,000 to 477 per 100,000 annually


2. Overall in-hospital complication rate was stable over time for spinal fusion and total knee arthroplasty; it increased for total hip arthroplasty from 9 percent to 10.3 percent.


3. In-hospital mortality rate decreased over time:


•    Spinal fusion: 1.1 percent to 0.6 percent
•    Total hip arthroplasty: 0.5 percent to 0.3 percent
•    Total knee arthroplasty: 0.3 percent to 0.2 percent


4. Overall in-hospital complication and mortality rate for these patients was significantly higher than patients who were 65 years old to 79 years old.


5. A 2012 study published in The Journal of Arthroplasty examined Medicare data for trends in primary and revision total hip arthroplasty, which showed primary total hip arthroplasty at high-volume hospitals increased slightly from 1991 to 2005, but revision procedures performed at high-volume hospitals increased 60.9 percent to 62.4 percent. The number of revision total hip arthroplasties at low-volume hospitals declined.


6. A retrospective review of hospital discharge data from the National Inpatient Sample that was published by the International Congress for Joint Reconstruction earlier this year, shows length of stay at the hospital decreased overall after total knee replacements for patients 65 years and older.


7. Medicare was the primary payer for 63.3 percent of all total knee replacements in 2000, but that number dropped to 54 percent in 2009. Private insurance paid for 30.7 percent of total knee arthroplasties in 2000 and 38.6 percent in 2009.


8. The percent of total knee replacement patients discharged with home health care increased from 19.1 percent in 2009 to 40.5 percent in 2009.


More articles on orthopedic surgery:
13 staffing metrics for orthopedics-driven ASCs
21 recent orthopedic surgeon moves
10 orthopedic surgeons making headlines this week

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