Orthopedic Specialty Hospitals Better Than General Hospitals?

Mrs. X goes to an orthopedic specialty hospital while Mrs. Y goes to a general hospital—both are treated with total knee arthroplasties. How do their results compare? A group of researchers recently decided to look at patient characteristics and outcomes at both U.S. orthopedic specialty hospitals and general hospitals. Their study, “Orthopaedic Specialty Hospitals Compared with General Hospitals: A Systematic Review of Demographic, Clinical, and Financial Parameters,” was published in the August 2021 edition of JBJS Reviews.

According to co-author Fotios Tjoumakaris, M.D., professor of orthopedic surgery and associate director of Sports Medicine Research at the Sidney Kimmel College of Medicine, Thomas Jefferson University in Philadelphia, the purpose of the study was to “Determine whether patient outcomes and satisfaction were superior at hospitals that rendered specialty orthopaedic care relative to general hospitals. In our geographic region, we were seeing a shift in patients preferring specialty hospital care for their orthopaedic needs and wanted to determine if this paradigm shift was evidence-based in treatment outcomes.”

The researchers queried PubMed and Embase from inception to April 2020 and pulled up 3,715 articles that addressed some aspect of the specialty hospital vs. general hospital paradigm. In total, the research team included 19 retrospective studies performed from 2005 to 2019 in their final analysis. The research team collected data regarding patient demographic characteristics, procedure volume, operative time and length of stay, adverse events, patient satisfaction, and hospital finances.

“There were conflicting results with regards to preferential patient selection and profitability,” wrote the authors. OSHs [orthopedic specialty hospitals] generate a greater surgical volume, while decreasing operative time and length of stay, compared with general hospitals. Adverse outcomes have been reported to be less common at orthopedic specialty hospitals; however, this benefit is not supported by recent matched-cohort studies. Only one study evaluated patient satisfaction, and this study demonstrated improved satisfaction with orthopedic specialty hospitals.”

Positive results…but why?

“I think our most important finding was that patients, overall, did prefer specialty orthopaedic hospitals as they garnered higher patient satisfaction scores,” said Dr. Tjoumakaris to OTW. “While outcomes also trended better at specialty hospitals, this may have been due to preferential patient selection.”

“The major implication of our work is that the care we deliver to patients should be based in evidence. While it’s clear that patients may prefer specialty care hospitals, a critical analysis of cost, treatment outcomes, and adverse events should continue to occur to make sure that the value-add to our system is in the best interest of the patient. Healthcare dollars are a limited resource, and we should continue to conserve this resource while providing the best product and outcome for the patient. Our team wanted to make sure that this paradigm shift in care wasn’t coming at the expense of patient care—and at least, for now, it generally isn’t.”