The U.S. News & World Report (USNWR) hospital rankings remain the most publicly referenced system for identifying "top" hospitals for each specialty. These authors sought to evaluate whether there are any differences in outcomes and costs for patients undergoing anatomic TSA (ATSA) or reverse TSA (RTSA) for degenerative pathologies at ranked (n=68) vs. nonranked hospitals (n=2,632)
A total of 82,417 TSAs were included in the study – out of which 8,868 (10.8%) were performed in one of the 68 hospitals that were ranked by the USNWR between 2011 and 2014. 73,549 arthroplasties were performed at unranked hospitals.
Following adjustment for baseline demographics, and clinical characteristics, there were no statistically significant differences between ranked vs. non-ranked hospitals, with regards to rates of infectious complications, dislocations, peri-prosthetic fractures, pulmonary embolism, deep venous thrombosis, myocardial infarction, sepsis, urinary tract infections, and readmissions.
Ranked hospitals were more likely to be in the Northeast, while unranked hospitals were more likely to be the South and West.
Unranked hospitals had higher percentages of patients with median household income <$36,250 and were more likely to be located in a rural setting.
Ranked hospitals, however, did have higher risk adjusted charges (+ $6,167; P < 0.001), and costs (+ $1.831; P < 0.001) across the entire episode of care.
The authors concluded that patients undergoing TSAs at ranked hospitals vs. non-ranked
hospitals have similar outcomes, despite the former facilities having higher costs and charges
across the episode of care.
Comment: These results are reassuring: they indicate that quality surgical care for patients needing shoulder arthroplasty are being achieved at the 90% of medical centers that do not appear in the US News ranks, including those that serve less well-to-do patients.