Data from a study published in the Jan. 4 issue of The Journal of Bone & Joint Surgery attempts to develop risk-adjusted models for Medicare inpatient and post-discharge adverse outcomes in elective lower-extremity total joint arthroplasty (TJA). 

The authors reviewed information on 253,978 total hip arthroplasty (THA) patients and 672,515 total knee arthroplasty (TKA) patients from the Medicare Limited Data Set database. They found that the overall adverse outcome rates were 12.0 percent for THA and 11.6 percent for TKA. Z-scores for 1,483 hospitals performing THA varied from -5.09 better than predicted to +5.62 poorer than predicted, and the risk-adjusted adverse outcome rates were 6.6 percent for the best-decile hospitals and 19.8 percent for the poorest-decile hospitals. Z-scores for 2,349 hospitals performing TKA varied from -5.85 better than predicted to +11.75 poorer than predicted, and the risk-adjusted adverse outcome rates were 6.4 percent for the best-decile hospitals and 19.3 percent for the poorest-decile hospitals. The authors write that the "risk-adjusted outcomes demonstrate wide variability and illustrate the need for improvement among poorer-performing hospitals for bundled payments of joint replacement surgical procedures." Learn more...