International Orthopaedics

, Volume 33, Issue 3, pp 643–651 | Cite as

Trends in mortality, complications, and demographics for primary hip arthroplasty in the United States

  • Spencer S. Liu
  • Alejandro González Della Valle
  • Melanie C. Besculides
  • Licia K. Gaber
  • Stavros G. Memtsoudis
Original Paper

Abstract

To determine trends in characteristics of total hip arthroplasty (THA) in the United States, the National Hospital Discharge Survey (NHDS) was analyzed from 1990 to 2004 for trends in in-hospital mortality and complications, length of hospital stay, demographics, and comorbidities. The number of THAs performed increased by 158%, whereas mortality rates remained low and slightly decreased (from 0.32% to 0.29%). Prevalence of procedure-related complications decreased over time, and length of stay decreased from an average of 8.7 days to 4.5 days. These improvements occurred despite an increase in comorbidities in patients. An increase in both the proportion of discharges to long- and short-term care facilities and in the proportion of procedures performed in smaller hospitals was noted. Multiple temporal changes in outcomes and demographics for THA were found. These changes have implications for clinical care and allocation of health resources.

Résumé

Le but de ce travail est de mettre en évidence les nouvelles données caractéristiques des prothèses totales de hanche aux Etats-Unis. Matériel et méthode: Le National Hospital Discharge Survey (NHDS) a été analysé durant la période de 1990 à 2004 sur le plan de la mortalité, des complications, de la durée de séjour, sur le plan démographique et des comorbidités. Résultat: le nombre de prothèses totales de hanche a augmenté de 158% dans cette période alors que la mortalité reste basse et a même légèrement diminué (0,32% à 0,29%). Le taux de complications et la durée moyenne de séjour diminuent également avec le temps de 8,7 jours à 4,5 jours. Ces améliorations entraînent néanmoins une augmentation des comorbidités chez les patients. Il a été noté une augmentation de la proportion des sorties avec prise en charge des soins de courte ou longue durée et une proportion importante de procédures réalisées dans les petits hôpitaux. les modifications notées sur le devenir et sur les bases démographiques des prothèses totales de hanche, ont une implication clinique sur les soins et sur l’allocation de ressource.

Notes

Acknowledgments

This study was performed with funds provided by the Hospital for Special Surgery Young Investigator Award (Dr. Memtsoudis) and by the Department of Anesthesiology, Hospital for Special Surgery. No conflicts of interest arise from any part of this study for any of the authors.

References

  1. 1.
    Ackerman IN, Graves SE, Bennell KL, Osborne RH (2006) Evaluating quality of life in hip and knee replacement: psychometric properties of the World Health Organization quality of life short version instrument. Arthritis Rheum 55:583–590PubMedCrossRefGoogle Scholar
  2. 2.
    Barrett J, Losina E, Baron JA, Mahomed NN, Wright J, Katz JN (2005) Survival following total hip replacement. J Bone Jt Surg Am 87:1965–1971CrossRefGoogle Scholar
  3. 3.
    Bhattacharyya T, Hooper DC (2007) Antibiotic dosing before primary hip and knee replacement as a pay-for-performance measure. J Bone Jt Surg Am 89:287–291CrossRefGoogle Scholar
  4. 4.
    Brunenberg DE, van Steyn MJ, Sluimer JC, Bekebrede LL, Bulstra SK, Joore MA (2005) Joint recovery programme versus usual care: an economic evaluation of a clinical pathway for joint replacement surgery. Med Care 43:1018–1026PubMedCrossRefGoogle Scholar
  5. 5.
    Centers for Disease Control and Prevention (2007) Selected articles using National Hospital Discharge Survey (NHDS) or National Survey of Ambulatory Surgery (NSAS) data. http://www.cdc.gov/nchs/data/hdasd/NHDS2007articleupdate.pdf. Accessed 10 March 2008
  6. 6.
    Chambers TA, Bagai A, Ivascu N (2007) Current trends in coronary artery disease in women. Curr Opin Anaesthesiol 20:75–82PubMedCrossRefGoogle Scholar
  7. 7.
    Crowninshield RD, Rosenberg AG, Sporer SM (2006) Changing demographics of patients with total joint replacement. Clin Orthop Relat Res 443:266–272PubMedCrossRefGoogle Scholar
  8. 8.
    Dennison C, Pokras R (2000) Design and operation of the National Hospital Discharge Survey: 1988 redesign. Vital and health statistics. Series 1–42. CDC, National Center for Health Statistics,Hyattsville, MDGoogle Scholar
  9. 9.
    Gandhi R, Petruccelli D, Devereaux PJ, Adili A, Hubmann M, de Beer J (2006) Incidence and timing of myocardial infarction after total joint arthroplasty. J Arthroplast 21:874–877CrossRefGoogle Scholar
  10. 10.
    Husted H, Hansen HC, Holm G, Bach-Dal C, Rud K, Andersen KL, Kehlet H (2006) Length of stay in total hip and knee arthroplasty in Denmark I: volume, morbidity, mortality and resource utilization. A national survey in orthopaedic departments in Denmark. Ugeskr Laeger 168:2139–2143PubMedGoogle Scholar
  11. 11.
    Judge A, Chard J, Learmonth I, Dieppe P (2006) The effects of surgical volumes and training centre status on outcomes following total joint replacement: analysis of the Hospital Episode Statistics for England. J Public Health (Oxf) 28:116–124CrossRefGoogle Scholar
  12. 12.
    Krotenberg R (2004) Current recommendations for extended out-of-hospital thromboprophylaxis following total hip arthroplasty. Am J Orthop 33:180–184PubMedGoogle Scholar
  13. 13.
    Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M (2005) Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Jt Surg Am 87:1487–1497CrossRefGoogle Scholar
  14. 14.
    Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Jt Surg Am 89:780–785CrossRefGoogle Scholar
  15. 15.
    Lavernia CJ, D’Apuzzo MR, Hernandez VH, Lee DJ, Rossi MD (2006) Postdischarge costs in arthroplasty surgery. J Arthroplast 21:144–150CrossRefGoogle Scholar
  16. 16.
    Lienhart A, Auroy Y, Pequignot F, Benhamou D, Warszawski J, Bovet M, Jougla E (2006) Survey of anesthesia-related mortality in France. Anesthesiology 105:1087–1097PubMedCrossRefGoogle Scholar
  17. 17.
    Lohmander LS, Engesaeter LB, Herberts P, Ingvarsson T, Lucht U, Puolakka TJ (2006) Standardized incidence rates of total hip replacement for primary hip osteoarthritis in the 5 Nordic countries: similarities and differences. Acta Orthop 77:733–740PubMedCrossRefGoogle Scholar
  18. 18.
    Martineau P, Filion KB, Huk OL, Zukor DJ, Eisenberg MJ, Antoniou J (2005) Primary hip arthroplasty costs are greater in low-volume than in high-volume Canadian hospitals. Clin Orthop Relat Res 152–156Google Scholar
  19. 19.
    Namba RS, Paxton L, Fithian DC, Stone ML (2005) Obesity and perioperative morbidity in total hip and total knee arthroplasty patients. J Arthroplast 20:46–50CrossRefGoogle Scholar
  20. 20.
    National Center for Health Statistics (2006) Health, United States, 2006. Available at: http://www.cdc.gov/nchs/data/hus/hus06.pdf. Accessed 10 March 2008
  21. 21.
    Nowygrod R, Egorova N, Greco G, Anderson P, Gelijns A, Moskowitz A, McKinsey J, Morrissey N, Kent KC (2006) Trends, complications, and mortality in peripheral vascular surgery. J Vasc Surg 43:205–216PubMedCrossRefGoogle Scholar
  22. 22.
    Parvizi J, Mui A, Purtill JJ, Sharkey PF, Hozack WJ, Rothman RH (2007) Total joint arthroplasty: when do fatal or near-fatal complications occur? J Bone Jt Surg Am 89:27–32CrossRefGoogle Scholar
  23. 23.
    Patel VP, Walsh M, Sehgal B, Preston C, DeWal H, Di Cesare PE (2007) Factors associated with prolonged wound drainage after primary total hip and knee arthroplasty. J Bone Jt Surg Am 89:33–38CrossRefGoogle Scholar
  24. 24.
    US Census Bureau (2006) National intercensal estimates (1990–2000). Available at: http://www.census.gov/popest/archives/EST90INTERCENSAL/US-EST90INT-datasets.html. Accessed 10 March 2008
  25. 25.
    Zhan C, Kaczmarek R, Loyo-Berrios N, Sangl J, Bright RA (2007) Incidence and short-term outcomes of primary and revision hip replacement in the United States. J Bone Jt Surg Am 89:526–533CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Spencer S. Liu
    • 1
  • Alejandro González Della Valle
    • 2
  • Melanie C. Besculides
    • 3
  • Licia K. Gaber
    • 4
  • Stavros G. Memtsoudis
    • 1
  1. 1.Department of Anesthesiology, Hospital for Special SurgeryWeill Medical College of Cornell UniversityNew YorkUSA
  2. 2.Department of Orthopaedics, Hospital for Special SurgeryWeill Medical College of Cornell UniversityNew YorkUSA
  3. 3.Mathematica Policy Research, Inc.PrincetonUSA
  4. 4.LKG ConsultingPlainsboroUSA

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