How should hospitals calculate total joint replacement complications? 5 key concepts

The researchers examined total and partial joint replacement patients in the American College of Surgeons National Surgical Quality Improvement Program database from 2008 to 2010. There were 23,924 patients who underwent the procedures at 95 hospitals included in the study. They looked at how including post-discharge VTE impacted hospital ranking.

Here are five findings examining the patients who reported VTE:

1. The VTE rate was 0.9 percent for the 8,499 hip arthroplasty patients. VTE rate for the 15,425 knee replacement patients included in the study was 1.9 percent.

2. Among the hip arthroplasty patients with VTE, 57.9 percent occurred after discharge. Around 28.2 percent of the VTE patients reported the complication after discharge.

3. On average, VTE occurred 11 days after surgery for hip replacement patients who reported the complication postoperatively; knee replacement patients typically reported VTE around three days after surgery. "Nearly twice as many VTE complications were captured if both pre-discharge and post-discharge events were considered, and inclusion of post-discharge events changed hospital quality rankings," concluded the study authors.

4. Both hip and knee replacement patients reported staying at the hospital for three days on average.

5. When ranking hospitals by VTE rates, the hospital outlier status designation changed when the researchers included post-discharge events. On average, the hospital quality ranking change was seven.

"These data suggest that inclusion of post-discharge events should be considered when comparing the quality of hospitals on the basis of postoperative VTE rates," concluded study authors.

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