Study Finds Around 80% of Medicare Patients Get TJA Revision Surgery at Same Hospital as Primary Procedure

AJRR has conducted a study analyzing the correlation between hospital size, the reason for revision surgery, and where total joint arthroplasty (TJA) revision surgery is performed. The link between these three factors has not been studied extensively until now.

Medicare hospital claims data and beneficiary enrollment data were used for the study. Medicare patients undergoing a TJA revision can sometimes have it performed by a different surgeon or at a different hospital than the primary procedure. The frequency of early infection and dislocation revisions performed following surgery by the same surgeon in the same hospital as the primary surgery is unclear. The study looks at whether there is an association between hospital size and where the revision is performed, and how frequently Medicare patients return to the same hospital or surgeon in the first year for joint infection or dislocation. 

One of the main findings of the study is that around 80 percent of Medicare patients who require revision in the first year actually do go back to the original hospital where surgery was performed. However, some patients with certain problems like infection, or those with issues that arise several years after surgery are much more likely to seek care at another hospital and from a different surgeon. These data have important implications for long-term survivorship results from any U.S. registry effort and highlight the need for comprehensive nationwide data gathering.

Additional study results include:

  • In hospitals with less than 150 beds, about 76% of revisions within one year were performed at the same hospital. This increases with hospital size.
  • In hospitals with over 450 beds, about 88% of revisions were performed at the same institution. For infection-related revisions within the first year, about 83% were at the same hospital, and about 80% were by the same surgeon.
  • With dislocation-related total hip arthroplasty (THA) revisions, about 87% were performed in the same hospital, and about 83% were performed by the same surgeon.

The lead author on the study was AJRR Annual Report Editor Terence J. Gioe, MD. Additional co-investigators included Edmund Lau, MS, and Heather Watson, PhD, of Exponent, Inc., along with AJRR Medical Director David G. Lewallen, MD, AAOS Registry Oversight Committee (ROC) Chair Daniel J. Berry, MD, and AJRR Director of Analytics Caryn D. Etkin, PhD, MPH. 

A poster of the study was on display during the American Academy of Orthopaedic Surgeons (AAOS) 2018 Annual Meeting. A PDF of the poster can be accessed on the AJRR website.

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