Senior Citizens Do Best in Specialized Orthopedic
Surgical Care: Medicare Study
Specialized hospitals have fewer serious
post-surgical complications ( blood clots, infections and heart
problems) or deaths
Feb. 15, 2010 - The more specialized a hospital is
in orthopedic surgical care, the better the outcomes appear to be for
senior citizen patients undergoing hip and knee replacement surgery,
University of Iowa researchers report in a new study of Medicare
patients.
Among more specialized hospitals, there were fewer
serious post-surgical complications such as blood clots, infections and
heart problems, as well as fewer deaths.
The findings, which were published online Feb. 11
by the British Medical Journal, were based on data for nearly 1.3
million patients who received hip or knee replacement surgeries between
2001 and 2005 at 3,818 hospitals in the United States.
"The findings suggest that more specialized
hospitals have better outcomes even after we account for the type of
patients each hospital cares for and the number of hip and knee
replacement surgeries that each hospital performs," said the study's
lead author Tyson Hagen, M.D., fellow in rheumatology at the UI Roy J.
and Lucille A. Carver College of Medicine and UI Hospitals and Clinics.
"While specialization appears to be an important
indicator of quality, it is just one factor that patients might want to
consider along with other important factors, such as how close the
hospital is to home," Hagen added.
By using Medicare data from 2001 to 2005, the study
was limited to the experience of patients age 65 and older. The study
authors used Medicare data since it is available for almost all
hospitals in the United States. While the study focused on people age 65
and older, the researchers said the findings indicate trends that could
be relevant to the larger population.
The study adjusted for differences in the types of
patient seen at each hospital, as well as the number of surgeries that
each hospital performed. Compared to the least specialized hospitals,
the more specialized hospitals treated a lower proportion of women and
African-Americans. These hospitals also treated patients who had better
health overall.
The results grouped hospitals into five levels of
specialization. At the average hospital, orthopedic surgeries, which
include back surgery and fracture repair in addition to joint
replacements, represented 10.5 percent of admissions. The most
specialized group in the current study included hospitals that had 14.5
percent or more admissions for orthopedic care. These hospitals had
fewer complications or deaths within the first 90 days after a surgery
than less specialized hospitals did.
For example, the rate of death for patients who had
hip and knee replacements was twice as high at the least specialized
hospitals compared to patients treated at the most specialized hospital
-- 1.4 percent compared to .7 percent within the first 90 days after
surgery.
In addition, the rate of post-surgery infection for
patients who got hip and knee replacements decreased from 2.6 percent at
the least specialized hospitals to 1.6 at the most specialized
hospitals.
The study's senior author Peter Cram, M.D., UI
associate professor of internal medicine, noted that larger hospitals
might do a relatively high volume of orthopedic surgical cases but often
were categorized as less specialized because they do so many other types
of surgeries besides orthopedics.
"Learning more about orthopedic specialization
could help us to better understand how to organize care and take ideas
from more specialized hospitals to less specialized hospitals, and
result in better outcomes all around," Cram said.
The study also involved the Center for Research in
the Implementation of Innovative Strategies at the Iowa City Veterans
Affairs Medical Center.
The study was supported in part by funding from the
National Institutes of Health. In addition, Cram is supported through
the Robert Wood Johnson Faculty Scholars Program.
Keep up with the latest news for senior citizens, baby
boomers
Feb. 15, 2010 - The more specialized a hospital is
in orthopedic surgical care, the better the outcomes appear to be for
senior citizen patients undergoing hip and knee replacement surgery,
University of Iowa researchers report in a new study of Medicare
patients.
