High-Volume Hospital Best for TSA

Having a total shoulder arthroplasty (TSA)? Pick a hospital that performs many procedures. As outlined in Arthritis Care and Research and reported by Wayne Kuznar of MedPage Today, “hospitals with higher TSA volume had significantly lower rates of two key surgical complications—post-arthroplasty fracture and revision.” This outcome held despite the fact that the higher volume hospitals dealt with more complex case loads.

A review of the Nationwide Inpatient Sample database provided the data. This is the largest all-payer inpatient care database in the U.S. It contains un-weighted data on about 8 million hospital stays each year. Researchers were Jasvinder A. Singh, MBBS, MPH, at the Birmingham, Alabama, VA Medical Center, and Rekha Ramachandran, MS, of the Mayo Clinic in Rochester, Minnesota.

According to Kuznar, the proportion of patients discharged to home was significantly higher in hospitals with a higher annual TSA volume. Length of stay was shorter in the high volume hospitals but there was no difference in the rate of inpatient mortality between the low and high volume hospitals. However, the rate of complications was higher in hospitals with a lower volume of TSA patients.

The authors wrote that their study “indicates that TSA procedures at hospitals with high volume are associated with better outcomes compared to hospitals with lower volume, despite a higher patient complexity. As such, referral of more complicated cases to high-volume centers should be considered.”