Knee Replacements Performed at High-Volume Hospitals Could Save Billions Annually

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A new study suggests that if patients scheduled for knee replacement surgery were directed to hospitals classified as high-volume for the procedure, the US healthcare system could benefit financially
A new study suggests that if patients scheduled for knee replacement surgery were directed to hospitals classified as high-volume for the procedure, the US healthcare system could benefit financially

A new study suggests that if patients scheduled for knee replacement surgery were directed to hospitals classified as high-volume for the procedure, the US healthcare system could benefit financially for the next 15 years.

Conducted by researchers at the Hospital for Special Surgery (HSS) in New York City, the report revealed that there could be a savings of between $2.5 and $5 billion annually by the year 2030 if patients scheduled for knee replacement were directed to "high-volume hospitals" for the surgery.

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"Numerous studies have shown lower complication rates and better outcomes in hospitals that do a high number of knee replacements compared to low-volume hospitals. Our study aimed to determine whether the lower rate of complications, hospital readmissions, and revision surgeries translated into cost savings," lead author Jayme Burket, PhD, said in a statement.

Examining data from the New York Statewide Planning and Research Cooperative System (SPARCS) from 1997-2014, the investigators compared the cost-effectiveness of elective knee replacement over a patient's lifetime in hospitals with various volume levels:

  • Low volume: less than 90 total knee replacements per year. 
  • Medium volume: 90-235 total knee replacements per year.
  • High volume: 236-644 total knee replacements per year.
  • Very high volume: 645 or more total knee replacements per year.

The researchers obtained complication, revision, mortality rates, and costs from SPARCS for middle-age (55-65 years) and Medicare-age patients (65-85 years). They identified 89 796 patients in the middle-age group and 111 492 cases in the Medicare group. For middle-age patients, 16% of surgeries were performed at low-volume hospitals; 31% at medium-volume; 32% at high-volume; and 20% at very high-volume centers.

The lowest lifetime costs and the greatest benefits were seen for total knee replacement in middle-age patients at very high-volume hospitals. Hospitals performing the most knee replacements showed the greatest cost-effectiveness across all hospital categories. The results were similar in the Medicare group, but the cost savings of very high-volume centers relative to  other categories were more modest than in the middle-age patient group.

"While regionalization may not be feasible for all patients, many low-volume hospitals are located in or near a metropolitan area with a high-volume hospital," Dr Buckett said. “Policy initiatives aiding to guide patients to higher-volume hospitals when available will not only reduce their risk for complications and improve outcomes, but will also considerably reduce the large financial burden knee replacement surgery places on our healthcare system."

Reference

Hospital for Special Surgery Develops Hip and Knee Replacement Measurement Survey. National Hospital for Special Surgery (HSS). https://www.hss.edu/hoos-jr-koos-jr-outcomes-surveys.asp. Accessed March 4, 2016.

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