Hospital Size and Teaching Status Equal Better Outcomes?

The size of a hospital and teaching status equates to better overall ankle arthroplasty patient outcomes, according to a new multi-center study.

The study, “The Impact of Hospital Size and Teaching Status on Outcomes Following Total Ankle Arthroplasty,” was published online in The Journal of Foot & Ankle Surgery on November 26, 2022.

The researchers said that the use of total ankle arthroplasty to treat ankle arthritis has increased significantly since 1998, but while new-generation implants have improved outcomes, there is little data regarding other variables which affect procedure outcomes.

For their study the investigators focused on two specific variables: The hospital itself and its teaching stats. To do this, the team pulled data from the Nationwide Inpatient Sample database for total ankle arthroplasty procedures performed between 2002 and 2012.

The investigators focused on such basic outcomes such as in-hospital mortality, length of stay, total hospital charges, discharge disposition, perioperative complications, and patient demographics. They categorized hospitals by size: small, medium, and large; and teaching status: rural non-teaching, urban non-teaching, and urban teaching.

Overall, the researchers were able to find 16,621 patient discharges over a 10-year period and, after analyzing the data, found significant length of stay and total charge differences—depending on hospital location and teaching status—but no significant difference in in-hospital mortality. Rural, non-teaching hospitals had higher risk of perioperative complications.

In an interview with OTW, the lead researcher Vani J. Sabesan, M.D., FAAOS, FAOA, a shoulder and elbow/sports medicine specialist in Florida explained, “The findings are sort of opposite of what the literature says, but this is why it is so important. Perhaps there is more expertise and volume in teaching hospitals.”

Sabesan and his colleagues wrote in their study, “Our analyses demonstrated important factors affecting cost and resource utilization for total ankle arthroplasty, clearly additional work is needed to optimize this relationship, especially in the upcoming bundled payment.”

Study authors include Diego J.L. Lima, M.D., of Cleveland Clinic Florida, Weston, Florida; Vani J. Sabesan, M.D., of Cleveland Clinic Florida and Wayne State University School of Medicine, Detroit, Michigan; Graysen R. Petersen-Fitts, M.D., of Beaumont Health System, Royal Oak, Michigan; Maxwell L. Winkler, B.S. and Matthew C. Sweet, B.S., of Wayne State University School of Medicine; Nikolas Bustamante Echeverry, B.S., of Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida and  James D. Whaley, M.D., and Beaumont Health System, Royal Oak, Michigan.