Centralization and the relationship between volume and outcome in knee arthroplasty procedures

Marlow, Nicholas E., Barraclough, Bruce, Collier, Neil A., Dickinson, Ian C., Fawcett, Jonathon, Graham, John C. and Maddern, Guy J. (2010) Centralization and the relationship between volume and outcome in knee arthroplasty procedures. ANZ Journal of Surgery, 80 4: 234-241. doi:10.1111/j.1445-2197.2010.05243.x


Author Marlow, Nicholas E.
Barraclough, Bruce
Collier, Neil A.
Dickinson, Ian C.
Fawcett, Jonathon
Graham, John C.
Maddern, Guy J.
Title Centralization and the relationship between volume and outcome in knee arthroplasty procedures
Journal name ANZ Journal of Surgery   Check publisher's open access policy
ISSN 1445-1433
1445-2197
Publication date 2010-04
Sub-type Article (original research)
DOI 10.1111/j.1445-2197.2010.05243.x
Volume 80
Issue 4
Start page 234
End page 241
Total pages 8
Place of publication Richmond VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Collection year 2011
Language eng
Formatted abstract
Background:
Centralization aims to reduce adverse patient outcomes by concentrating complex surgical procedures in specified hospitals.

Objectives:
This review assessed the efficacy of centralization for knee arthroplasty by examining the relationship between hospital and surgeon volume and patient outcomes.

Data Sources and Review Methods:
The systematic review identified studies using multiple databases, including Medline and Embase. Two independent researchers ensured studies met the inclusion criteria. Morbidity, mortality, length of stay, financial outcomes and statistical rigour were examined. Correlations between volume and outcome were reported.

Results:
Twelve primary knee arthroplasty studies examined hospital volume, which was significantly associated with decreased morbidity (five of seven studies), mortality (two of five studies) and length of stay (two of three studies). Three primary knee arthroplasty studies examined surgeon volume, which was significantly associated with decreased morbidity (two of three studies), mortality (zero of two studies) and length of stay (one of one study). Two revision knee arthroplasty studies examined hospital volume. One study examined but did not test for significance between hospital volume and patient morbidity; both studies examined volume and patient mortality reporting inconclusive results; and one study reported no significant association between volume and length of stay. None of the revision knee arthroplasty studies examined surgeon volume.

Conclusions:
Significant associations between increased hospital and surgeon volume and improved patient outcomes were reported. However, when these results were separated by arthroplasty type, the association appeared tenuous. Judgements regarding centralization of knee arthroplasty should be made with caution until further evidence is published. © 2010 Royal Australasian College of Surgeons.
Keyword Arthroplasty
Knee replacement
Orthopedics
Review
Surgery
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 13 times in Thomson Reuters Web of Science Article | Citations
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Created: Fri, 18 Mar 2011, 09:53:22 EST by Mrs Maureen Pollard on behalf of PA - Southside Clinical School