Total shoulder arthroplasty (TSA) at United States News and World Report top-ranked hospitals in orthopedics – do rankings correlate with complications and cost?

Abstract

IntroductionThe U.S. News & World Report (USNWR) hospital rankings remain the most publicly referenced system for identifying top hospitals for each specialty. The current study aims to evaluate whether there are any differences in outcomes and costs for patients undergoing anatomic TSA (ATSA) or reverse TSA (RTSA) for degenerative pathologies at ranked vs. non–ranked hospitals. MethodsThe 2011-2014 USNWR hospital rankings were used to identify ranked hospitals in “Orthopedics.” The 2011-2014 100% Medicare Standard Analytical Files (SAF100) were used to identify patients undergoing ATSA or RTSA for degenerative arthritis. The study cohort was divided into two groups, based on whether patients received surgery at a ranked hospital vs. a non–ranked hospital. Multi-variate logistic and linear regression analyses were used to assess for differences in 90-day outcomes and costs between ranked and non–ranked hospitals, while controlling for potential co-variates/confounders. ResultsA total of 82,417 TSA were included in the study – out of which 8,868 (10.8%) were performed in one of the 68 hospitals that were ranked by the USNWR between 2011 and 2014. Following adjustment for baseline demographics, and clinical characteristics, there were no statistically significant differences between ranked vs. non–ranked hospitals, with regards to rates of infectious complications (0.8% vs. 1.0%, OR 0.91 [95% CI 0.82-1.01]; P = .079), dislocations (0.8% vs. 0.9%, OR 1.07 [95% CI 0.79-1.43]; P = .658), peri-prosthetic fractures (0.3% vs. 0.3%, OR 0.77 [95% CI 0.47-1.21]; P = .269), pulmonary embolism (0.7% vs. 0.8%, OR 0.88 [95% CI 0.64-1.20]; P = .435), deep venous thrombosis (1.1% vs. 0.9%, OR 1.21 [95% CI 0.93-1.56]; P = .153), myocardial infarction (0.4% vs. 0.5%, OR 1.00 [95% CI 0.67-1.46]; P = .995), sepsis (6.0% vs. 7.3%, OR 0.95 [95% CI 0.85-1.05]; P = .314), urinary tract infections (4.8% vs. 5.6%, OR 0.99 [95% CI 0.87-1.11]; P = .831) and readmissions (7.1% vs. 8.3%, OR 0.91 [95% CI 0.82-1.01]; P = .079). Ranked hospitals, however, did have higher risk-adjusted charges (+ $6,167; P < .001), and costs (+ $1.831; P < .001) across the entire episode of care. ConclusionBased on our findings, patients undergoing TSA at ranked hospitals vs. non–ranked hospitals have similar outcomes, despite the former facilities having higher costs and charges across the episode of care. Level of EvidenceLevel III