These authors used Nationwide Inpatient Sample (NIS) to determine how hospital volume and other factors affect quality for patients undergoing total hip and knee arthroplasty from 2001 to 2011.
Patients were grouped into quartiles based on the corresponding hospital’s procedure volume.
The quality measurement for each hospitalization was binary, with perfect inpatient care reflecting a favorable result for all of the following outcomes of interest: death, sepsis, postoperative infection, thromboembolic events, venous thrombosis, hematoma, blood transfusion, and length of stay below average. The Perfect Inpatient Care Index (PICI) was then calculated for each hospital. The PICI was defined as the number of hospitalizations with no unfavorable outcomes divided by total volume of arthroplasty. Value was measured as the PICI divided by the mean total charges.
The quality measurement for each hospitalization was binary, with perfect inpatient care reflecting a favorable result for all of the following outcomes of interest: death, sepsis, postoperative infection, thromboembolic events, venous thrombosis, hematoma, blood transfusion, and length of stay below average. The Perfect Inpatient Care Index (PICI) was then calculated for each hospital. The PICI was defined as the number of hospitalizations with no unfavorable outcomes divided by total volume of arthroplasty. Value was measured as the PICI divided by the mean total charges.
From 2001 to 2011, the NIS database reported 1,651,354 total hip or total knee arthroplasties. Hospital arthroplasty volume ranged from 0 to 11,758 procedures. Overall, hospital PICI scores increased as arthroplasty volume increased. This relationship continued at the highest levels
of procedure volume, with hospitals that performed >4,063 procedures (top 1%) still outperforming other hospitals in the top quartile of procedure volume.
of procedure volume, with hospitals that performed >4,063 procedures (top 1%) still outperforming other hospitals in the top quartile of procedure volume.
Value increased as hospital procedure volume increased.
In multivariable nested regression analysis, lower procedure volume, increasing patient age, female sex, non-white race, high patient acuity, Medicaid insurance were associated with lower Perfect Inpatient Care Indices
Comment: This study shows that high hospital case volume and low patient acuity are major drivers of patient outcome and that the benefit of higher volume continues even among hospitals in the highest volume quartile.
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