Top

Journal of Orthopaedic Surgery and Research

Published in:

Open Access 01-12-2023 | Care | Research article

In France, distance from hospital and health care structure impact on outcome after arthroplasty of the hip for proximal fractures of the femur

Authors: Mathieu Levaillant, Louis Rony, Jean-François Hamel-Broza, Julien Soula, Benoît Vallet, Antoine Lamer

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2023

Abstract

Background

Hip arthroplasty is a frequently performed procedure in orthopedic surgery, carried out in almost all health structures for two main issues: fracture and coxarthrosis. Even if volume–outcome relationship appeared associated in many surgeries recently, data provided are not sufficient to set surgical thresholds neither than closing down low-volumes centers.

Question

With this study, we wanted to identify surgical, health care-related and territorial factors influencing patient’ mortality and readmission after a HA for a femoral fracture in 2018 in France.

Patients and methods

Data were anonymously collected from French nationwide administrative databases. All patients who underwent a hip arthroplasty for a femoral fracture through 2018 were included. Patient outcome was 90-day mortality and 90-day readmission rate after surgery.

Results

Of the 36,252 patients that underwent a HA for fracture in France in 2018, 0.7% died within 90-day year and 1.2% were readmitted. Male and Charlson comorbidity index were associated with a higher 90-day mortality and readmission rate in multivariate analysis. High volume was associated with a lower mortality rate. Neither time of travel nor distance upon health facility were associated with mortality nor with readmission rate in the analysis.

Conclusion

Even if volume appears to be associated with lower mortality rate even for longer distance and time of travel, the persistence of exogenous factors not documented in the French databases suggests that regionalization of hip arthroplasty should be organized with caution.

Clinical relevance

As volume–outcome relationship must be interpreted with caution, policy makers should not regionalize such surgery without further investigation.

Available only for authorised users

Rony L, Lancigu R, Hubert L. Intraosseous metal implants in orthopedics: a review. Morphologie. 2018;102:231–42. https://doi.org/10.1016/j.morpho.2018.09.003.CrossRefPubMed

Healy WL, Iorio R, Clair AJ, Pellegrini VD, Della Valle CJ, Berend KR. Complications of total hip arthroplasty: standardized list, definitions, and stratification developed by the hip society. Clin Orthop Relat Res. 2016;474:357–64. https://doi.org/10.1007/s11999-015-4341-7.CrossRefPubMed

Gademan MGJ, Hofstede SN, Vliet Vlieland TPM, Nelissen RGHH, Marang-van de Mheen PJ. Indication criteria for total hip or knee arthroplasty in osteoarthritis: a state-of-the-science overview. BMC Musculoskelet Disord. 2016;17:463. https://doi.org/10.1186/s12891-016-1325-z.CrossRefPubMedPubMedCentral

Guyen O. Hemiarthroplasty or total hip arthroplasty in recent femoral neck fractures? Orthop Traumatol Surg Res. 2019;105:S95-101. https://doi.org/10.1016/j.otsr.2018.04.034.CrossRefPubMed

Pollock M, Somerville L, Firth A, Lanting B. Outpatient total hip arthroplasty, total knee arthroplasty, and unicompartmental knee arthroplasty: a systematic review of the literature. JBJS Rev. 2016. https://doi.org/10.2106/JBJS.RVW.16.00002.CrossRefPubMed

El Amrani M, Clement G, Lenne X, Farges O, Delpero J-R, Theis D, et al. Failure-to-rescue in patients undergoing pancreatectomy: is hospital volume a standard for quality improvement programs? Nationwide analysis of 12,333 patients. Ann Surg. 2018;268:799–807. https://doi.org/10.1097/SLA.0000000000002945.CrossRefPubMed

El Amrani M, Clement G, Lenne X, Rogosnitzky M, Theis D, Pruvot F-R, et al. The impact of hospital volume and Charlson score on postoperative mortality of proctectomy for rectal cancer: a nationwide study of 45,569 patients. Ann Surg. 2018;268:854–60. https://doi.org/10.1097/SLA.0000000000002898.CrossRefPubMed

Morche J, Mathes T, Pieper D. Relationship between surgeon volume and outcomes: a systematic review of systematic reviews. Syst Rev. 2016;5:204. https://doi.org/10.1186/s13643-016-0376-4.CrossRefPubMedPubMedCentral

Pasquer A, Renaud F, Hec F, Gandon A, Vanderbeken M, Drubay V, et al. Is centralization needed for esophageal and gastric cancer patients with low operative risk? A nationwide study. Ann Surg. 2016;264:823–30. https://doi.org/10.1097/SLA.0000000000001768.CrossRefPubMed

10.

Gani F, Azoulay D, Pawlik TM. Evaluating trends in the volume-outcomes relationship following liver surgery: does regionalization benefit all patients the same? J Gastrointest Surg. 2017;21:463–71. https://doi.org/10.1007/s11605-016-3316-7.CrossRefPubMed

11.

Wiegers EJA, Sewalt CA, Venema E, Schep NWL, Verhaar JAN, Lingsma HF, et al. The volume–outcome relationship for hip fractures: a systematic review and meta-analysis of 2,023,469 patients. Acta Orthop. 2019;90:26–32. https://doi.org/10.1080/17453674.2018.1545383.CrossRefPubMedPubMedCentral

12.

Goldberg: The French health information system - Google Scholar n.d. https://scholar.google.com/scholar_lookup?journal=Journal+of+the+International+Association+for+Official+Statistics&title=The+French+public+health+information+system&author=M+Goldberg&author=E+Jougla&author=M+Fassa&author=R+Padieu&author=C+Quantin&volume=28&publication_year=2012&pages=31-41&.Accessed 17 May 2022.

13.

Bezin J, Duong M, Lassalle R, Droz C, Pariente A, Blin P, et al. The national healthcare system claims databases in France, SNIIRAM and EGB: powerful tools for pharmacoepidemiology. Pharmacoepidemiol Drug Saf. 2017;26:954–62. https://doi.org/10.1002/pds.4233.CrossRefPubMed

14.

Tuppin P, Rudant J, Constantinou P, Gastaldi-Ménager C, Rachas A, de Roquefeuil L, et al. Value of a national administrative database to guide public decisions: From the système national d’information interrégimes de l’Assurance Maladie (SNIIRAM) to the système national des données de santé (SNDS) in France. Rev Epidemiol Sante Publique. 2017;65(Suppl 4):S149–67. https://doi.org/10.1016/j.respe.2017.05.004.CrossRefPubMed

15.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83. https://doi.org/10.1016/0021-9681(87)90171-8.CrossRefPubMed

16.

Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi J-C, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43:1130–9. https://doi.org/10.1097/01.mlr.0000182534.19832.83.CrossRefPubMed

17.

Agrawal D, Cruz I, Jensen C, Ofek E, Tanin E. In: Proceedings of the 19th ACM SIGSPATIAL international conference on advances in geographic information systems 2011. https://doi.org/10.1145/2093973.

18.

OpenStreetMap contributors. Planet dump retrieved from https://planet.osm.org 2017.

19.

Maceroli M, Nikkel LE, Mahmood B, Ketz JP, Qiu X, Ciminelli J, et al. Total hip arthroplasty for femoral neck fractures: improved outcomes with higher hospital volumes. J Orthop Trauma. 2016;30:597–604. https://doi.org/10.1097/BOT.0000000000000662.CrossRefPubMedPubMedCentral

20.

O’Mahoney PRA, Yeo HL, Sedrakyan A, Trencheva K, Mao J, Isaacs AJ, et al. Centralization of pancreatoduodenectomy a decade later: impact of the volume–outcome relationship. Surgery. 2016;159:1528–38. https://doi.org/10.1016/j.surg.2016.01.008.CrossRefPubMed

21.

Yoshioka R, Yasunaga H, Hasegawa K, Horiguchi H, Fushimi K, Aoki T, et al. Impact of hospital volume on hospital mortality, length of stay and total costs after pancreaticoduodenectomy: outcome-volume relationship for pancreaticoduodenectomy. Br J Surg. 2014;101:523–9. https://doi.org/10.1002/bjs.9420.CrossRefPubMed

22.

Juillard C, Lashoher A, Sewell CA, Uddin S, Griffith JG, Chang DC. A national analysis of the relationship between hospital volume, academic center status, and surgical outcomes for abdominal hysterectomy done for leiomyoma. J Am Coll Surg. 2009;208:599–606. https://doi.org/10.1016/j.jamcollsurg.2009.01.003.CrossRefPubMed

23.

Mukhtar RA, Kattan OM, Harris HW. Variation in annual volume at a university hospital does not predict mortality for pancreatic resections. HPB Surg. 2008;2008:1–6. https://doi.org/10.1155/2008/190914.CrossRef

24.

Xia L, Taylor BL, Mamtani R, Christodouleas JP, Guzzo TJ. Associations between travel distance, hospital volume, and outcomes following radical cystectomy in patients with muscle-invasive bladder cancer. Urology. 2018;114:87–94. https://doi.org/10.1016/j.urology.2017.12.014.CrossRefPubMed

25.

Beal EW, Mehta R, Hyer JM, Paredes A, Merath K, Dillhoff ME, et al. Association between travel distance, hospital volume, and outcomes following resection of cholangiocarcinoma. J Gastrointest Surg. 2019;23:944–52. https://doi.org/10.1007/s11605-019-04162-8.CrossRefPubMed

26.

Bendzsak AM, Baxter NN, Darling GE, Austin PC, Urbach DR. Regionalization and outcomes of lung cancer surgery in Ontario, Canada. JCO. 2017;35:2772–80. https://doi.org/10.1200/JCO.2016.69.8076.CrossRef

27.

Beal EW, Mehta R, Merath K, Tsilimigras DI, Hyer JM, Paredes A, et al. Outcomes after resection of hepatocellular carcinoma: intersection of travel distance and hospital volume. J Gastrointest Surg. 2019;23:1425–34. https://doi.org/10.1007/s11605-019-04233-w.CrossRefPubMed

28.

Laucis NC, Chowdhury M, Dasgupta A, Bhattacharyya T. Trend toward high-volume hospitals and the influence on complications in knee and hip arthroplasty. J Bone Jt Surg. 2016;98:707–12. https://doi.org/10.2106/JBJS.15.00399.CrossRef

29.

Matar HE, Jenkinson R, Pincus D, Satkunasivam R, Paterson JM, Ravi B. The association between surgeon age and early surgical complications of elective total hip arthroplasty: propensity-matched cohort study (122,043 patients). J Arthroplasty. 2021;36:579–85. https://doi.org/10.1016/j.arth.2020.08.040.CrossRefPubMed

30.

Gonzalez AA, Sutzko DC, Osborne NH. A national study evaluating hospital volume and inpatient mortality after open abdominal aortic aneurysm repair in vulnerable populations. Ann Vasc Surg. 2018;50:154–9. https://doi.org/10.1016/j.avsg.2017.11.049.CrossRefPubMed

31.

Ravi B, Jenkinson R, Austin PC, Croxford R, Wasserstein D, Escott B, et al. Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study. BMJ. 2014;348:g3284. https://doi.org/10.1136/bmj.g3284.CrossRefPubMedPubMedCentral

32.

Ahola R, Siiki A, Vasama K, Vornanen M, Sand J, Laukkarinen J. Effect of centralization on long-term survival after resection of pancreatic ductal adenocarcinoma. Br J Surg. 2017;104:1532–8. https://doi.org/10.1002/bjs.10560.CrossRefPubMed

33.

Choi H, Yang S-Y, Cho H-S, Kim W, Park E-C, Han K-T. Mortality differences by surgical volume among patients with stomach cancer: a threshold for a favorable volume-outcome relationship. World J Surg Oncol. 2017;15:134. https://doi.org/10.1186/s12957-017-1203-7.CrossRefPubMedPubMedCentral

34.

Dixon M, Mahar A, Paszat L, McLeod R, Law C, Swallow C, et al. What provider volumes and characteristics are appropriate for gastric cancer resection? Results of an international RAND/UCLA expert panel. Surgery. 2013;154:1100–9. https://doi.org/10.1016/j.surg.2013.05.021.CrossRefPubMed

35.

Gutacker N, Bloor K, Cookson R, Gale CP, Maynard A, Pagano D, et al. Hospital surgical volumes and mortality after coronary artery bypass grafting: using international comparisons to determine a safe threshold. Health Serv Res. 2017;52:863–78. https://doi.org/10.1111/1475-6773.12508.CrossRefPubMed

36.

Stitzenberg KB, Sigurdson ER, Egleston BL, Starkey RB, Meropol NJ. Centralization of cancer surgery: implications for patient access to optimal care. JCO. 2009;27:4671–8. https://doi.org/10.1200/JCO.2008.20.1715.CrossRef

37.

Ward MM, Jaana M, Wakefield DS, Ohsfeldt RL, Schneider JE, Miller T, et al. What would be the effect of referral to high-volume hospitals in a largely rural state? J Rural Health. 2004;20:344–54. https://doi.org/10.1111/j.1748-0361.2004.tb00048.x.CrossRefPubMed

Title: In France, distance from hospital and health care structure impact on outcome after arthroplasty of the hip for proximal fractures of the femur
Authors: Mathieu Levaillant
Louis Rony
Jean-François Hamel-Broza
Julien Soula
Benoît Vallet
Antoine Lamer
Publication date: 01-12-2023
Publisher: BioMed Central
Keyword: Care
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2023
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-023-03893-4

EASD 2024

Springer Medicine

In France, distance from hospital and health care structure impact on outcome after arthroplasty of the hip for proximal fractures of the femur

Abstract

Background

Question

Patients and methods

Results

Conclusion

Clinical relevance

EASD 2024

Springer Medicine

Abstract

Background

Question

Patients and methods

Results

Conclusion

Clinical relevance

Please log in to get access to this content

Other articles of this Issue 1/2023

Lateral lumbar interbody fusion (LLIF) reduces total lifetime cost compared with posterior lumbar interbody fusion (PLIF) for single-level lumbar spinal fusion surgery: a cost-utility analysis in Thailand

Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes

In-office needle arthroscopy is a cost-effective alternative for operating room diversion in medial meniscectomy: a financial analysis

Mid-term low back pain improvement after total hip arthroplasty in 306 patients with developmental dysplasia of the hip

Metformin regulates chondrocyte senescence and proliferation through microRNA-34a/SIRT1 pathway in osteoarthritis

The patient-related factors in revision procedures on tibia of patients with osteogenesis imperfecta treated with the Peter-Williams nail