Outcomes of patients undergoing primary total knee arthroplasty in orthopedic specialty hospitals of Korea
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Total knee arthroplasty (TKA) is a common and effective surgical procedure for severe knee arthritis and is one of the most increasingly popular procedures in developed countries. In 2011, the Korean Government designated hospitals that had been focusing on specific diseases or procedures as specialty hospitals. The aim of this study was to compare outcomes of TKA specialty hospitals and non-specialty hospitals. Observational data collected from the National Health Insurance Claims Data of the Health Insurance Review and Assessment Service included 36,934 patients who underwent primary TKA at hospitals during 2012. Outcomes of TKA were unplanned readmission and adverse events. Age, sex, health insurance status, and comorbidity using Charlson’s Index were used to adjust for covariates. A generalized estimating equation (GEE) was used to compare outcomes of specialty hospitals and non-specialty hospitals. The unplanned readmission rates within 30 days of discharge of specialty and non-specialty hospitals were 12.1% and 10.1%, respectively. Patients who underwent TKA in specialty hospitals experienced fewer adverse events within 90 days of surgery compared to those who underwent the procedure in non-specialty hospitals (1.3% vs. 1.9%). However, the outcomes were not significantly different after adjusting for covariates. Further studies are needed to determine whether the outcomes of specialty hospitals become better than those of non-specialty hospitals in order to examine the effect of the designation policy.
Abstract
Total knee arthroplasty (TKA) is a common and effective surgical procedure for severe knee arthritis and is one of the most increasingly popular procedures in developed countries. In 2011, the Korean Government designated hospitals that had been focusing on specific diseases or procedures as specialty hospitals. The aim of this study was to compare outcomes of TKA specialty hospitals and non-specialty hospitals. Observational data collected from the National Health Insurance Claims Data of the Health Insurance Review and Assessment Service included 36,934 patients who underwent primary TKA at hospitals during 2012. Outcomes of TKA were unplanned readmission and adverse events. Age, sex, health insurance status, and comorbidity using Charlson’s Index were used to adjust for covariates. A generalized estimating equation (GEE) was used to compare outcomes of specialty hospitals and non-specialty hospitals. The unplanned readmission rates within 30 days of discharge of specialty and non-specialty hospitals were 12.1% and 10.1%, respectively. Patients who underwent TKA in specialty hospitals experienced fewer adverse events within 90 days of surgery compared to those who underwent the procedure in non-specialty hospitals (1.3% vs. 1.9%). However, the outcomes were not significantly different after adjusting for covariates. Further studies are needed to determine whether the outcomes of specialty hospitals become better than those of non-specialty hospitals in order to examine the effect of the designation policy.
참고문헌 (15)
- Adeyemo, D., "Unplanned general re-admissions – how many, which patients and why?", Ann R Coll Surg Engl, 89(4), pp.363~367 (2007)
- Casalino, L.P., "Focused factories? Physician-owned specialty facilities", Health Affairs, 22(6), pp.56~67 (2003)
- Medicare Hospital Quality Chartbook – Performance Report on Outcome Measures, "Centers for Medicare and Medicaid Services", ~ (2012)
- Medicare Hospital Quality Chartbook – Performance Report on Outcome Measures, "Centers for Medicare and Medicaid Services", ~ (2013)
- Courtney, E.D, "28-day emergency surgical readmission rates as a clinical indicator of performance", Ann R Coll Surg Engl, 85(2), pp.75~78 (2003)
- Cram, P., "A comparison of total hip and knee replacement in specialty and general hospitals", The Journal of Bone & Joint Surgery, 89(8), pp.1675~1684 (2007)
- Cram, P., "Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991–2010", Journal of the American Medical Association, 308(12), pp.1227~1236 (2012)
- "Hospital-wide all-cause unplanned readmission measure: final technical report. Baltimore (MD):Centers for Medicare and Medicaid Services 2012"[URL]
- Health-Care Reform in Korea, "Jones, R.S", OECD Economics Department, ~, pp.OECD Economics Department Working Papers, 797 (2010)
- Katz, J. N., "Case mix and outcomes of total knee replacement in orthopaedic specialty hospitals", Medical Care, 46(5), pp.476~480 (2008)
- Khatod, M., "Knee replacement: epidemiology, outcomes, and trends in Southern California", Acta Orthopaedica, 79(6), pp.812~819 (2008)
- Memtsoudis, S.G., "Trends in demographics, comorbidity profiles, in-hospital complications and mortality associated with primary knee arthroplasty", The Journal of Arthroplasty, 24(4), pp.518~527 (2009)
- "Health Statistics 2013a" (2016)[URL]
- OECD, "Health at a Glance 2013: OECD Indicators" (2013), OECD Publishing
- Schairer, W.W., "What are the rates and causes of hospital readmission after total knee arthroplasty?", Clinical Orthopaedics and Related Research, 472(1), pp.181~187 (2014)