Commentary on an article by Jeffrey N. Katz, MD, MSc, et al.: “Choice of Hospital for Revision Total Hip Replacement”

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Katz et al., utilizing the Medicare data base, attempt to answer two questions: (1) On a numerical basis, does a revision of a primary total hip arthroplasty occur in the same hospital as the primary procedure, or in a different hospital? and (2) Do higher-volume hospitals perform a disproportionate number of revision arthroplasties (compared with the number of primary arthroplasties performed at the hospital and the expected number of revisions that would be generated)? The results have potentially important health policy implications. Previous studies involving the use of two large databases, the Medicare claims database and the Nationwide Inpatient Sample database, have given insight into the relationship between surgeon volume and the early outcomes of total hip arthroplasty, early complication rates after primary and revision total hip arthroplasty, and the types of revisions performed. In 2008, Manley et al. reported on the effect of surgical volume on early revision rates less than six months after the primary total hip arthroplasty and showed that patients who were managed by a surgeon who performed more than fifty total hip arthroplasties annually were less likely to have undergone a revision total hip arthroplasty than those who …