Utilization and short-term outcomes of primary total hip and knee arthroplasty in the United States and Canada: an analysis of New York and Ontario administrative data
Cram P, Landon BE, Matelski J, Ling V, Stukel TA, Paterson JM, Gandhi R, Hawker GA, Ravi B. Arthritis Rheumatol. 2018; 70(4):547-54. Epub 2017 Dec 29.
Objective — Total knee and total hip arthroplasty (TKA and THA) are common and effective surgical procedures. We compared utilization and short-term outcomes of primary TKA and THA in adjacent regions of Canada and the United States.
Methods — Retrospective cohort study of patients who underwent primary TKA or THA using administrative data from New York (NY) and Ontario in 2012-2013. We compared TKA and THA patient demographics, per-capita utilization, and short-term outcomes between jurisdictions.
Results — A higher percentage of NY hospitals performed TKA compared to Ontario (75.7% vs 42.1%; P<.001) and mean hospital volume was lower in NY (179 vs 327; P<.001). After direct standardization, utilization was significantly lower in NY compared to Ontario for both TKA (16.2 TKAs per 10,000 population per-year in NY vs 21.4 in Ontario; P<.001) and THA (10.5 in NY vs 11.5 in Ontario; P<.001). For TKA Ontario hospitals' LOS was significantly longer compared to NY (3.7 vs 3.4 days; P<.001). A smaller percentage of NY patients were discharged directly home (46.2% vs 90.9%; P<.001), but 30-day and 90-day readmission rates were higher in NY compared to Ontario (30-day: 4.6% vs 3.9%; P<.001)(90-day: 8.4% vs 6.7%; P<.001). Results were similar for THA.
Conclusion — Ontario has higher TJA utilization than NY, but a smaller percentage of hospitals performing these procedures. Patients are more likely to be discharged home and less likely to be readmitted in Ontario. Our results suggest areas where each jurisdiction could improve.