Skip Navigation



Journal of Public Health Advance Access published online on April 5, 2006
Journal of Public Health, doi:10.1093/pubmed/fdl003
This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
28/2/116    most recent
fdl003v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Judge, A.
Right arrow Articles by Dieppe, P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Judge, A.
Right arrow Articles by Dieppe, P.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Author 2006, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved

Article

The effects of surgical volumes and training centre status on outcomes following total joint replacement: analysis of the Hospital Episode Statistics for England

Andy Judge 1 *, Jiri Chard 2, Ian Learmonth 3, and Paul Dieppe 1

1 MRC Health Services Research Collaboration, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK
2 National Collaborating Centre for Womens’ and Childrens’ Health, Royal College of Obstetrics and Gynaecology, 27 Sussex Place, Regent’s Park, London NW1 4RG, UK
3 Department of Orthopaedic Surgery, University of Bristol, Dolphin House, Bristol Royal Infirmary, Bristol BS2 8HW, UK

* To whom correspondence should be addressed.
Andy Judge, E-mail: andrew.judge{at}bristol.ac.uk


  Abstract

Objective Previous work from other countries has shown a significant inverse relationship between the number of some surgical procedures undertaken in a hospital and in an adverse outcomes. In the light of the changing nature of the provision of joint replacements in the United Kingdom, we have examined the effects of surgical volumes and the presence/absence of training centre status, on outcomes following total joint replacement (TJR) in England.

Methods Analysis of the Hospital Episode Statistics (HES) on all hip/knee joint replacements in English National Health Service (NHS) trusts between financial years 1997 and 2002. Exposures explored were the volume of hip/knee replacements per annum in an NHS trust, training centre status and whether the admission was routine or emergency. Four surrogate measures of adverse outcome were assessed: 30-day in-hospital mortality, length of stay in hospital, readmission within a year and surgical revision within 5 years. Age and sex were controlled for as potential confounders.

Results Data from a total of 281 360 hip replacements and 211 099 knee replacements were examined. HES data show that the numbers of TJRs performed in low volume trusts are small and decreasing. Adverse outcomes were also uncommon. Nevertheless, significant associations between adverse outcomes and low volume units, and better outcomes in training centres, were detected. For example, the odds ratio (OR) for in-hospital death within 30 days of hip replacement in trusts doing <50 hip/replacements per annum is 1.98 [95% confidence interval (95% CI) = 1.13-3.47] compared with trusts doing 251-500 operations/annum. Similarly, surgery in non-training centres is more likely to result in mortality than that in training centres (OR = 1.25, 95% CI = 1.05-1.48). The examination of surgical revision indicated adverse outcomes in higher volume units; this may be due to case-mix.

Conclusion In England, there are fewer adverse events following TJR in high volume centres and in orthopaedic training centres. Standardization of procedures may account for this finding. The data have implications for private practice in the United Kingdom and for the current move to undertake TJRs in Independent Sector Treatment Centres.

Keywords: adverse outcomes, hip replacement, hospital admission, knee replacement, surgical volume.
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?




Disclaimer:
Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.