Regional and hospital variance in performance of total hip and knee replacements: a national population-based study

Abstract

Introduction. This article in the supplement on the Performance, Effectiveness, and Costs of Treatment episodes (PERFECT)-project describes the PERFECT Hip and Knee Replacement Database and its possibilities by evaluating regional and hospital-level differences in length of stay (LOS), costs and complication rates of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in Finland.

Material and methods. All hip and knee arthroplasties are recorded in the Finnish Hospital Discharge Register (FHDR) and Finnish Arthroplasty Register (FAR). LOS, length of uninterrupted institutional care (LUIC), complication rates and other parameters of treatment were determined by region and hospital during 1998–2008 based on these.

Results. LOS and LUIC following THA and TKA diminished during the follow-up period. In 1998 average LOS after THA and TKA was 9.9 and 10 days. In 2008, these had shortened to 5.2 and 5.3 days, respectively. There was a 5.0 and 7.5 percentage point difference in revision rate between regions in THAs and TKAs, respectively, performed during 2005–2007 and followed to the end of 2009.

Discussion. The Finnish health care registers provide a monitoring system for evaluating hospital- and regional-level differences in THA and TKA. The differences in LOS, LUIC and revision rates between hospitals and regions are considerable.

Key words::

• Follow-up studies
• outcome and process assessment (health care)
• registries
• specialization
• total hip arthroplasty
• total knee arthroplasty

Acknowledgements

Other members of the Perfect group: are Heikki Kröger, Juhana Leppilahti, Miika Linna, Olavi Nelimarkka, Ilmo Parvinen, Seppo Seitsalo and Jarmo Vuorinen.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Funding/support: Research in the database has been supported by unrestricted grants from the Finnish Academy, the Finnish Innovation Fund SITRA and Helsinki University Central Hospital EVO funding.

Role of the sponsors: The funding sources for this study had no role in the design or conducting of the study; in the collection, management, analysis and interpretation of the data; or in the preparation, review or approval of the manuscript.