Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Apr;87(4):341-8.
doi: 10.1016/j.mayocp.2011.11.017.

Total knee arthroplasty outcomes in top-ranked and non-top-ranked orthopedic hospitals: an analysis of Medicare administrative data

Peter Cram  1 , Xueya Cai, Xin Lu, Mary S Vaughan-Sarrazin, Benjamin J Miller
Affiliations

Total knee arthroplasty outcomes in top-ranked and non-top-ranked orthopedic hospitals: an analysis of Medicare administrative data

Peter Cram et al. Mayo Clin Proc. 2012 Apr.

Abstract

Objective: To examine outcomes of Medicare enrollees who underwent primary total knee arthroplasty (TKA) in top-ranked orthopedic hospitals identified through the U.S. News & World Report hospital rankings and 2 comparison groups of hospitals.

Patients and methods: We used Medicare Part A data to identify patients who underwent primary TKA between January 1, 2006, and December 31, 2006, in 3 groups of hospitals: (1) top-ranked according to U.S. News & World Report rankings; (2) not top-ranked, but eligible for ranking; and (3) not eligible for ranking by U.S. News & World Report. We compared the demographics and comorbidity of patients treated in the 3 hospital groups. We examined rates of postoperative adverse outcomes--a composite consisting of hemorrhage, pulmonary embolism, deep vein thrombosis, wound infection, myocardial infarction, or mortality within 30 days of surgery. We also compared 30-day all-cause readmission rates and hospital length of stay (LOS) across groups.

Results: Our cohort consisted of 48 top-ranked hospitals (performing 10,477 primary TKAs), 288 eligible non-top-ranked hospitals (28,938 TKAs), and 481 hospitals not eligible for ranking (25,297 TKAs). Unadjusted rates of the composite outcome were modestly higher for top-ranked hospitals (4.3%, 455 patients) as compared with non-top-ranked hospitals (4.1%, 1191 patients) and hospitals ineligible for ranking (3.3%, 843 patients) (P<.001), but these differences were no longer significant after accounting for differences in patient complexity. Likewise, there were no significant differences in readmission rates or LOS across groups.

Conclusion: Rates of postoperative complications and readmission and hospital LOS were similar for Medicare patients who underwent primary TKA in top-ranked and non-top-ranked hospitals.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Flowchart of selection of hospitals. AHA = American Hospital Association; HRR = hospital referral region; TKA = total knee arthroplasty.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Green J., Wintfeld N., Krasner M., Wells C. In search of America's best hospitals: the promise and reality of quality assessment. JAMA. 1997;277(14):1152–1155. - PubMed
    1. Larson R.J., Schwartz L.M., Woloshin S., Welch H.G. Advertising by academic medical centers. Arch Intern Med. 2005;165(6):645–651. - PubMed
    1. Rosenthal G.E., Chren M.M., Lasek R.J., Landefeld C.S. The annual guide to “America's best hospitals”: evidence of influence among health care leaders. J Gen Intern Med. 1996;11(6):366–369. - PubMed
    1. Chen J., Radford M.J., Wang Y., Marciniak T.A., Krumholz H.M. Do “America's Best Hospitals” perform better for acute myocardial infarction? N Engl J Med. 1999;340(4):286–292. - PubMed
    1. Mulvey G.K., Wang Y., Lin Z. Mortality and readmission for patients with heart failure among U.S. News & World Report's top heart hospitals. Circ Cardiovasc Qual Outcomes. 2009;2(6):558–565. - PubMed

Publication types