Gesundheitswesen 2021; 83(08/09): 757
DOI: 10.1055/s-0041-1732748
Freitag 24.09.2021
Vorträge

Hospital volume-outcome relationship in total knee arthroplasty: a systematic review and dose-response meta-analysis

T Rombey
1   Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke, Köln, Deutschland
,
K Goossen
1   Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke, Köln, Deutschland
,
C Kugler
1   Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke, Köln, Deutschland
,
KK De Santis
1   Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke, Köln, Deutschland
2   Leibniz Institut für Präventiosforschung und Epidemiologie (BIPS), Bremen, Deutschland
,
J Breuing
1   Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke, Köln, Deutschland
,
T Mathes
1   Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke, Köln, Deutschland
,
S Hess
1   Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke, Köln, Deutschland
,
R Burchard
3   Klinik für Orthopädie und Unfallchirurgie, Lahn-Dill-Kliniken Dillenburg, Dillenburg, Deutschland
4   Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Deutschland
5   Zentrum für Orthopädie und Unfallchirurgie, Universität Gießen und Marburg, Marburg, Deutschland
,
D Pieper
1   Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke, Köln, Deutschland
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Purpose In Germany, there is a minimum volume threshold for total knee arthroplasty (TKA) of 50 procedures per hospital per year, although it is unclear whether a hospital volume-outcome relationship exists for TKA. The objective of this systematic review was to investigate this relationship.

Methods We included cohort studies which involved patients who had undergone TKA, reported at least two different hospital volumes, and considered patient-relevant outcomes. To identify studies, we systematically searched MEDLINE, Embase, CENTRAL, and CINAHL, up to 12/02/2020. The risk of bias and confidence in the cumulative evidence were assessed with ROBINS-I and GRADE, respectively. We calculated odds ratios (ORs) and 95% confidence intervals per 50 additional TKAs/year.

Results A total of 68 studies with data from 1985 to 2018, mostly from the US or Germany, were included. Most studies had a moderate or serious overall risk of bias. Higher hospital volume may be associated with lower rates of revisions ≤12 months (narrative synthesis, k=7 studies, n=301 378 patients). Our dose-response meta-analysis of adjusted values showed that higher hospital volume is likely associated with lower rates of mortality ≤3 months (OR 0.98 [0.97 to 0.99], k=9, n=2 638 996) and readmission ≤3 months (OR 0.98 [0.97 to 0.99], k=3, n=830 381). The confidence in the cumulative evidence was moderate (mortality, readmissions) or low (early revisions). There was very low-certainty evidence for deep infections (1-4 years), late revisions and other adverse events.

Conclusions There is evidence that a volume-outcome relationship probably exists for TKA supporting the use of a minimum volume threshold.

Funding German Federal Ministry of Education and Research - BMBF (reference number 01KG1805).

Registration PROSPERO (CRD42019131209).



Publication History

Article published online:
02 September 2021

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