THA, TKA Outcomes Steadily Improving – New Data

A new study from Yale University’s School of Medicine looking at data from 2.1 million total hip arthroplasty and total knee arthroplasty cases has found that both complication rates and readmission rates declined steadily between 2010 and 2017.

Their study, “Quality Measure Public Reporting Is Associated with Improved Outcomes Following Hip and Knee Replacement,” appears in the July 15, 2020 edition of The Journal of Bone and Joint Surgery.

Co-author Lisa Suter, M.D., of the Yale-New Haven Health System Center for Outcome Research and Evaluation, described the genesis of this project to OTW. “This work arose from regular monitoring of hospital performance and quality measure results performed by the Center for Outcomes Research and Evaluation (CORE) under contract to the Centers for Medicare and Medicaid Services (CMS).”

“Starting in 2013, CMS [Centers for Medicare and Medicaid Services] has publicly reported hospital-level total hip and knee arthroplasty (THA/TKA) risk-standardized complication and readmissions rates (RSCRs and RSRRs). CORE developed the THA/TKA complication and readmission quality measures (under contract to CMS) and reevaluates the measures annually.”

“This paper summarizes hospital measure results over several years and explores the temporal association of trends in measure results with their public reporting and inclusion in payment programs. The total hip and total knee readmission measure was included in the Hospital Readmission Reduction Program starting in 2015 and the total hip and total knee complication measure was included in CMS’ Hospital Value-Based Purchasing Program starting in 2019.”

Suter’s research team used data from Medicare’s fee-for-service beneficiaries who were 65 years of age or older (HIPPA compliant) and who’d been discharged from non-federal acute-care hospitals following an elective primary THA and/or TKA. The research team excluded patients who’d had nonelective arthroplasty procedures, had mechanical complications present on admission, or received arthroplasty-related procedures associated with a substantially different outcome risk (those undergoing revision, partial hip replacement and/or resurfacing, or removal of implanted devices).

According to the study authors, “For readmission data, all eligible hospitalizations from July 2010 to June 2017 were included. For complication data, all eligible hospitalizations from April 2010 to March 2017 were included…”

In total, 2,148,823 elective primary THA and TKA procedures performed at 3,705 hospitals from 2010 to 2017 were included in this study’s in the complication analysis; 2,240,438 procedures from 3,702 hospitals were included in the readmission analysis.

Sounding cautiously optimistic, Dr. Suter told OTW, “Both the rates of and variation in hospital-level THA/TKA complication and readmission outcomes declined steadily between 2010 and 2017. There is evidence supporting that clinical efforts to improve outcomes and perioperative care for joint replacement patients has led to reduced complications and readmissions after elective primary THA/TKA procedures. This paper demonstrates that outcomes are improving after elective primary THA/TKA procedures. However, ongoing monitoring for unintended consequences of measurement is needed.”