High Volume Hospitals Cut Joint Replacement Costs

Want to save the U.S healthcare system from $2.5 to $4 billion a year by 2030? Then schedule all patients for knee replacement surgery to high-volume hospitals. A study conducted at Hospital for Special Surgery (HSS) in New York City found that patients experienced lower complication rates and better outcomes in hospitals that do a high number of knee replacements as compared to low-volume hospitals.

Lead study author Jayme Burket, Ph.D. said, “We found that knee replacement surgery at higher-volume hospitals is less costly over a patient’s lifetime and provides better outcomes, and if all knee replacements were performed at these hospitals, it could save between $15 and $23 million annually in New York State alone.”

Douglas Padgett, M.D., chief of the Adult Reconstruction and Joint Replacement Service at HSS, said, “This is the first study to include a younger patient population in addition to Medicare patients in a cost-effectiveness analysis of total knee replacement. This is important because patients under 65 now account for about 50 percent of those having the procedure. The list of complications included in our study was also much more comprehensive than those in previous analyses.”

Researchers compared the cost-effectiveness of elective knee replacement over a patient’s lifetime in low, medium, high, and very high-volume hospitals. They defined the volume categories as follows: Low volume was defined as less than 90 knee replacements per year, medium volume was 90 to 235 replacements per year, high volume was 236 to 644 total knee replacements per year and very high volume was 645 or more total knee replacements per year.

According to a report in EurekAlert!, total knee replacements in younger patients when performed at very high-volume hospitals, were associated with the lowest lifetime costs and the greatest benefits. Those performing the highest volume knee replacements showed significantly greater cost-effectiveness than all other hospital categories.

Results were similar in the Medicare group. However, the cost savings of very high-volume centers were more modest than in the younger patient group. Researchers estimate that, based on current trends, 2.8 million patients will be able to schedule their surgery at very high-volume hospitals annually by the year 2030. The researchers presented their study, “Cost-Effectiveness of Total Knee Arthroplasty at High Volume Hospitals” at the annual meeting of the American Academy of Orthopaedic Surgeons in Orlando, Florida.