Joint Replacement Risks Rise at Less Experienced Hospitals

Study finds greater likelihood of clots, death when few operations are done

TUESDAY, June 7 (HealthDay News) -- People who have hip or knee replacement surgery at hospitals that do relatively few surgeries are at greater risk for serious complications after the procedure, new research reveals.

Blood clots were more common among patients at hospitals with low surgical volume, as were deaths within a year of their surgery, according to the study, published online June 7 in Arthritis & Rheumatism.

According to the U.S. Centers for Disease Control and Prevention, about 230,000 total hip replacements and 543,000 total knee replacements are performed each year in the United States.

"With the large number of elective arthroplasty [joint replacements] in the U.S., it is important to understand the impact of peri- and post-operative medical complications on the success of joint replacement surgery," the study's lead author, Dr. Jasvinder Singh of the University of Alabama, said in a news release from the journal's publisher. "Possible cardiac complications, blood clots or infections increase patient morbidity and mortality risk, which can lead to higher health-care utilization and costs."

For the study, Singh and his fellow researchers compiled data on 10,187 hip and 19,418 knee replacement surgeries performed in Pennsylvania in 2002. The recipients, who averaged 69 years old, included more women than men.

People who had a hip replaced at a hospital that did 200 or fewer surgeries a year were more likely to develop a blood clot that travels to the lungs, called a pulmonary embolism, within 30 days of surgery than were those who had their surgery at a high-volume hospital, which did more than 200 surgeries a year.

The risk of dying within a year of the surgery was higher for people who had total hip replacements at a low-volume hospital and for those 65 and older who had a total knee replacement at a hospital with low surgical volume.

The researchers reasoned that the higher risk for complications at hospitals with low surgical volume may be linked to hospital procedures, including the prevention and treatment of blood clots.

"Further studies are needed to investigate whether the underlying reasons for poor surgical outcomes at low-volume hospitals are modifiable and which interventions may reduce complications for patients at these facilities," Singh said.

More information

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more on joint replacement surgery.

Mary Elizabeth Dallas SOURCE: Arthritis & Rheumatism, news release, June 7, 2011

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