AJRR: Study on Hospital Size, Revision Procedure Correlation

The American Joint Replacement Registry (AJRR), part of the American Academy of Orthopaedic Surgeons’ (AAOS) registries portfolio, has conducted a novel (unpublished) study analyzing the correlation between hospital size, the reason for revision (or re-do) surgery, and where total joint arthroplasty (TJA) revision surgery is performed.

Lead study author and adjunct professor of orthopedic surgery, University of Minnesota Medical School, Terence J. Gioe, M.D., told OTW, “Hospital-based or regional registries are typically limited in their catchment area, making loss to follow-up a major concern when patients move out of the area or otherwise receive subsequent medical care outside of the original hospital network.”

“We chose to assess the migration patterns of TJA patients in order to help improve recruitment and enrollment efforts of the AJRR. Furthermore, the magnitude and characteristics of patient migration following TJA have not previously been studied in the U.S.”

AJRR Director of Analytics Caryn D. Etkin, Ph.D., M.P.H. commented to OTW, “As we began our registry, there was a concern that AJRR might not be capturing a substantial percentage of revisions. We expected ‘leakage,’ in that we thought patients could potentially visit a non-participating institution for their revision and AJRR would not capture those procedures.”

“However, given that over 80% of 1-year revisions occur in the same institution, that leakage might not be as much of a concern in the early revision stage. These revisions are critical, as they may be indicative of implants with a high early failure rate, surgeon technique, or other hospital factors.”

“Additional analyses found that this fraction dropped off substantially as the duration from primary to revision arthroplasty increased. So, in the long-term, AJRR needs to continue to enroll hospitals on a nationwide basis in order to capture longer-term revisions.”

“The likelihood of attending a different hospital for revision strengthened with increasing time since the primary arthroplasty. These findings reinforce the risk of biased results when implant performance is assessed based only on revisions that can be captured within a limited set of hospitals. Research into implant performance must take precautions to minimize incomplete capture of revision and other post-primary outcomes due to migration or other factors that result in changing facilities at the time of revision.”