Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991–2010
By P. Cram, Xin Lu, S. Kates, J. Singh, Yue Li, B. Wolf. Journal of the American Medical Association (JAMA), 2012
888 citations recorded by the source corpus.
Context Total Knee Arthroplasty (TKA) is one of the most common and costly surgical procedures performed in the United States (U.S.). Objective To examine longitudinal trends in volume, utilization and outcomes for primary and revision TKA between 1991 and 2010 in the U.S. Medicare population. Design, Setting, and Participants Observational cohort of 3,271,851 patients who underwent primary TKA and 318,563 who underwent revision TKA identified in Medicare Part A data files. Outcomes We examined changes in primary and revision TKA volume, per-capita utilization, hospital length of stay (LOS), readmission rates, and adverse outcomes. Results Between 1991 and 2010 annual primary TKA volume increased 161.5% from 93,230 to 226,177 while per-capita utilization increased 99.2%. Revision TKA volume increased 105.9% from 9,650 to 19,871 while utilization increased 56.8%. For primary TKA, LOS decreased from 7.9 days (95% CI, 7.8–7.9) in 1991–1994 to 3.5 days (95% CI, 3.5-3.5) in 2007–2010 (P< 0.001). For primary TKA rates of adverse outcomes resulting in readmission remained stable between 1991–2010, but rates of all-cause 30-day readmission increased from 4.2% (95% CI, 4.1–4.2) to 5.0% (95% CI, 4.9–5.0) (P<0.001). For revision TKA, the decline in hospital LOS was accompanied by an increase in 30-day readmission from 6.1% (95% CI, 5.9–6.4) to 8.9% (95% CI, 8.7–9.2) (P<.001) and an increase in wound infection rates from 1.4% (95% CI, 1.3–1.5) to 3.0% (95% CI, 2.9–3.1) (P<.001). Conclusions Increases in TKA volume have largely been driven by increases in per-capita utilization. We also observed decreases in hospital LOS that were accompanied by increases in hospital readmission rates.
Subfields: Surgery
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Citations in the corpus
- Why are total knee arthroplasties failing today--has anything changed after 10 years? (2014, background): “Since its introduction, total knee arthroplasty (TKA) has evolved into one of the most successful and thoroughly investigated surgical interventions, especially over thepast twodecades [1].”
- Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021. (2014, background): “We sought to address the following research questions: (1) Was the incidence of total joint replacement surgery, especially among the privately insured patients, impacted by the economic downturns of 2001 and 2008 to 2009? (2) Are the historical trends in the utilization of joint replacement surgery”