RESUMO
INTRODUCTION: Hip and knee arthroplasty are high volume, clinically successful, but costly orthopedic surgical procedures. There is significant variation in volume, outcomes, and cost at various hospitals. METHODS: Using the Statewide Planning and Research Cooperative System (SPARCS) database to determine readmission rates and the New York State Department of Health (NYSDoH) hospital cost transparency database to obtain costs, we reviewed this data for hip and knee replacements to determine if there was a relationship between volume of procedures performed and cost or readmission rates. RESULTS: The readmission rate increased with increasing cost for facilities performing total knee arthroplasty (p = 0.02). Readmission rate did not change significantly with volume of procedures performed. Similarly, the readmission rate increased with increasing cost for facilities performing total hip arthroplasty but did not change significantly with respect to volume (p < 0.01). CONCLUSION: Spending more money to perform total hip and knee arthroplasty in New York State does not ensure lower readmission rates. Readmission rates vary independent of volume of procedures performed. Total hip and knee arthroplasty are two of the most successful and commonly performed orthopedic surgical procedures. Outcome investigations demonstrate reliable pain relief and consistently good or excellent functional outcomes.1-3 However, there is significant variability in both cost and quality of these procedures, resulting in a wide difference in their value. Porter defines value as outcomes divided by cost.4 One metric that reflects both the cost as well as the quality of care is the unplanned readmission rate. Whether readmission occurs as a result of thromboembolic disease, surgical site infection, or cardiopulmonary complications in the postoperative period, it represents a deterioration of outcome at a significant cost burden to the treating institution. The New York State Department of Health's Statewide Planning and Research Cooperative System (SPARCS) database was established in 1979. Licensed hospitals in the state are mandated to report data on all discharges, including inpatient and outpatient surgery procedures and emergency department admissions.5 On December 5, 2013, the New York State Department of Health made hospital-specific average costs for over 300 diagnosis-related groups (DRGs) available publicly on its website.6 Among the selected DRGs were total hip (301) and total knee (302) arthroplasty. The purpose of this study was to determine if there was a relationship between quality (as indicated by readmission rate) and either volume of procedures performed or cost of performing those procedures.