Yes, it probably is time to consider a Center of Excellence for Revision Total Joint Arthroplasties.
A team of University of Rochester School of Medicine researchers looked at the theoretical possibility of situating revision total joint arthroplasty (TJA) in higher-volume hospitals and the relationship to access to care issues. The results of their inquiry appears in a paper titled “Does Hypothetical Centralization of Revision THA and TKA Exacerbate Existing Geographic or Demographic Disparities in Access to Care By Increased Patient Travel Distances or Times? A Large-database Study,” in the December 6, 2021, edition of Clinical Orthopaedics and Related Research.
“We continue to look for ways to improve patient outcomes, reduce readmissions, and reduce complications of both primary and revision total joint arthroplasty,” said co-author Benjamin Ricciardi, M.D. to OTW. “There have been many recent studies examining the advantages to higher volume centers for revision total joint replacement, however, in practice, centralizing patients to only high-volume centers may create or exacerbate existing access to care issues.”
“Health inequality is a persistent problem in our healthcare system, and joint replacement is no exception. We wanted to conduct a study to attempt to understand the possible consequences of policies that attempt to direct patients to higher volume centers that need revision joint replacement.”
Working from the Statewide Planning and Research Cooperative System administrative database for New York State, the researchers found 37,147 patients who had in-patient stays for revision total joint arthroplasty from 2008 to 2016. They then divided hospitals into quartiles according to the mean revision total joint arthroplasty volume.
“We found that centralization of revision total joint arthroplasty care in New York State would not create an additional travel burden of greater than 60 minutes/60 miles for most patients under the policies that we examined,” Dr. Ricciardi told OTW. “However, patients from rural, lower income areas tend to be most affected with regard to travel burden so prior to enacting these policies, a focus on reducing the potential impact on this patient population would be warranted.”
The authors suggest that future research might look into designating Centers of Excellence for revision total joint arthroplasty, the impact of using best practices in lower-volume institutions on revision total joint arthroplasty, and other care opportunities such as telemedicine.
