Complications after hip arthroplasty and the association with hospital procedure volume

Abstract

Background and purpose It has been suggested that a higher procedure volume is associated with less complications after hip arthroplasty. In order to investigate the incidence of serious negative outcomes and a possible association with procedure volume, we performed a retrospective nationwide cohort study on total hip replacements in all Dutch hospitals.

Methods All total hip replacements (n = 50,080) that were identified as primary intervention in all general and university medical centers between January 1, 2002 and October 1, 2004 were included. Primary endpoints of follow-up were mortality and complications during admission, and re-admission within 3 months due to complications. Variables that were assessed as potential risk factor were age, sex, duration of (preoperative) admission, specific diagnosis, acute/non-planned admission, co-morbidity, and hospital procedure volume.

Results Age, sex, and comorbidity were associated with complications and mortality. Additionally, acute admission was a risk factor for mortality but not for complications. There was no linear trend indicating that decreasing volume led to an increasing number of complications, and no statistically sginificant effect for mortality was found.

Interpretation After adjustment for several risk factors, we found that the hospitals performing most hip procedures every year had fewer complications during index admission, but that they did not have a lower mortality than groups performing fewer procedures. The lack of a linear trend may be explained by the fact that almost all Dutch hospitals perform a high number of hip arthroplasties each year.

All authors were involved in the conception and design of the study, and approved the final manuscript. LMdV performed data analysis, interpreted results, and wrote the manuscript. BHCS collected and assembled the data and contributed to the analysis and interpretation. MCJMS and JANV contributed to interpretation of the results.

The authors thank J Verkroost-Van Heemst for her assistance in the validation of the data and Dr J. de Koning and Dr S. A. Romio for critically reviewing the manuscript.

No competing interests declared.