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Effect of provider volume on resource utilization for surgical procedures of the knee

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Operating-room time and patient disposition on discharge are important determinants of healthcare resource utilization and cost. We examined the relation between these determinants and hospital/surgeon volume for anterior cruciate ligament (ACL) reconstruction and meniscectomy procedures. Patients undergoing ACL reconstruction (18,390 cases) and meniscectomy (123,012 cases) were extracted from the State Ambulatory Surgery Databases for the years 1997–2000. Surgeon and hospital volume were divided into low-, intermediate-, and high-volume categories. Multivariate logistic regression models were used to estimate the adjusted association between surgeon and hospital volume and patient discharge status and operating-room time. Patients undergoing ACL reconstruction or meniscectomy performed by low-volume surgeons were significantly more likely to be non-routinely discharged as compared to high-volume surgeons (adjusted odds ratio 3.5, 95% confidence interval 1.7–7.2 for ACL reconstruction; adjusted odds ratio 2.0, 95% confidence interval 1.6–2.3 for meniscectomy). The mean operating-room time for performing ACL reconstruction or meniscectomy was significantly higher in low- and intermediate-volume surgeons and hospitals as compared to high-volume surgeons and hospitals (p≤0.001). High-volume providers utilize healthcare resources more efficiently. Our findings may help surgeons and hospitals in optimizing resource utilization and cost for routinely-performed ambulatory surgery procedures.

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Author information

Authors and Affiliations

  1. Center for Excellence in Surgical Outcomes, Duke University Medical Center, Durham, NC, USA

    Nitin Jain, Ricardo Pietrobon, Ulrich Guller, Anoop Shankar, Ajit S. Ahluwalia & Laurence D. Higgins

  2. Division of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA

    Ricardo Pietrobon & Laurence D. Higgins

  3. Divisions of General Surgery and Surgical Research, Department of Surgery, University of Basel, Basel, Switzerland

    Ulrich Guller

  4. Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA

    Anoop Shankar

Authors
  1. Nitin Jain
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  2. Ricardo Pietrobon
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  3. Ulrich Guller
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  4. Anoop Shankar
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  5. Ajit S. Ahluwalia
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  6. Laurence D. Higgins
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Corresponding author

Correspondence to Nitin Jain.

Appendix

Appendix

Inclusion criteria

For anterior cruciate ligament (ACL) reconstruction

  • All ambulatory surgery procedures with the following primary procedure code:

    • 81.45—Other repairs of cruciate ligaments

  • The ACL reconstruction surgery should have one of the following diagnostic code (any diagnosis):

    • 717.83—Old disruption of anterior cruciate ligament

    • 844.2—Sprain of cruciate ligament of knee

For meniscectomy

  • All ambulatory surgery procedures with the following primary procedure code:

    • 80.6—Excision of meniscus of knee

  • The meniscectomy surgery should have one of the following diagnostic code (any diagnosis):

    • 717.0—Old bucket-handle tear of medial meniscus

    • 717.1—Derangement of anterior horn of medial meniscus

    • 717.2—Derangement of posterior horn of medial meniscus

    • 717.3—Other and unspecified derangement of medial meniscus

    • 717.4—Derangement of lateral meniscus

    • 717.40—Derangement of lateral meniscus, unspecified

    • 717.41—Bucket-handle tear of lateral meniscus

    • 717.42—Derangement of anterior horn of lateral meniscus

    • 717.43—Derangement of posterior horn of lateral meniscus

    • 717.49—Other derangement of lateral meniscus

    • 717.5—Derangement of meniscus, not elsewhere classified

    • 836.0—Tear of medial cartilage or meniscus of knee, current

    • 836.1—Tear of lateral cartilage or meniscus of knee, current

    • 836.2—Other tear of cartilage or meniscus of knee, current

Exclusion criteria

For ACL reconstruction and meniscectomy

  • Patients with diagnosis of lower-leg bone infection:

    • 730.06—Acute osteomyelitis of lower leg

    • 730.16– Chronic osteomyelitis of lower leg

    • 730.26—Unspecified osteomyelitis

    • 730.36—Periostitis without mention of osteomyelitis

    • 730.86—Other infections involving bone in diseases classified elsewhere

    • 730.96—Unspecified infection of bone

    • 996.60—Infection of inflammatory reaction due to unspecified internal prosthetic device, implant, and graft

    • 996.67—Infection or inflammation due to presence of unspecified orthopedic device, implant and graft

  • Patients with a diagnostic code that indicates that present surgery is for correction of a previous complication of ACL reconstruction or meniscectomy:

    • 996.4—Mechanical complication of internal orthopedic device, implant, and graft

    • 996.70—Other complications of unspecified internal (biological) (synthetic) prosthetic device, implant, and graft

    • 996.78—Other complications of internal orthopedic (biological) (synthetic) prosthetic device, implant, and graft

    • 996.79—Other complications of internal (biological) (synthetic) prosthetic device, implant, and graft

  • Patients with malignancies or pathological fractures of tibia, fibula or femur:

    • 170.7—Malignant neoplasms of long bones of lower limb

    • 196.5—Secondary and unspecified malignant neoplasm of lymph nodes in inguinal region and lower limb

    • 733.15—Pathological fracture of other specified part of femur (other than neck)

    • 733.16—Pathologic fracture of tibia or fibula

  • Patients with fracture of tibia, fibula, patella or femur due to injury:

    • 821.00, 821.01, 821.10, 821.11, 821.20, 821.21, 821.22, 821.23, 821.29, 821.30, 821.31, 821.32, 821.33, 821.39—Fracture of other and unspecified parts of femur (other than neck)

    • 822.0, 822.1—Fracture of patella

    • 823.00, 823.01, 823.02, 823.10, 823.11, 823.12, 823.20, 823.21, 823.22, 823.30, 823.31, 823.32, 823.80, 823.81, 823.82, 823.90, 823.91, 823.92—Fracture of tibia and fibula

  • Patients undergoing knee arthroplasty along with a ACL reconstruction or meniscectomy:

    • 81.54—Total knee replacement

    • 81.55—Revision of knee replacement

  • Patients with a diagnosis of rheumatoid arthritis:

    • 714.0—Rheumatoid arthritis

    • 714.1—Felty’s syndrome

    • 714.2—Other rheumatoid arthritis with visceral or systemic involvement

    • 714.30—Polyarticular juvenile rheumatoid arthritis, chronic or unspecified

    • 714.31—Polyarticular juvenile rheumatoid arthritis, acute

    • 714.32—Pauciarticular juvenile rheumatoid arthritis

    • 714.33—Monoarticular juvenile rheumatoid arthritis

  • Patients with less than 45 minutes of operating room time for ACL reconstruction and less than 20 minutes of operating room time for meniscectomy

Procedures included as a part of ACL reconstruction or meniscectomy

For ACL reconstruction

  • 77.65—Local excision of lesion or tissue of bone from femur

  • 77.66—Local excision of lesion or tissue of bone from patella

  • 77.67—Local excision of lesion or tissue of bone from tibia and fibula

  • 77.75—Excision of bone for graft from femur

  • 77.76—Excision of bone for graft from patella

  • 77.77—Excision of bone for graft from tibia and fibula

  • 78.05—Bone graft from femur

  • 78.06—Bone graft from patella

  • 78.07—Bone graft from tibia and fibula

  • 80.16—Other arthrotomy of knee

  • 80.26—Arthroscopy of knee

  • 80.46—Division of knee joint capsule, ligament, or cartilage

  • 80.6—Excision of semilunar cartilage of knee

  • 80.76—Synovectomy of knee joint

  • 80.86—Other local excision or destruction of lesion of knee joint

  • 81.46—Other repairs of collateral ligaments

  • 81.47—Other repair of knee

  • 83.41—Excision of tendon for graft

  • 83.81—Tendon graft

  • 83.82—Graft of muscle or fascia

For meniscectomy

  • 77.65—Local excision of lesion or tissue of bone from femur

  • 77.66—Local excision of lesion or tissue of bone from patella

  • 77.67—Local excision of lesion or tissue of bone from tibia and fibula

  • 77.75—Excision of bone for graft from femur

  • 77.76—Excision of bone for graft from patella

  • 77.77—Excision of bone for graft from tibia and fibula

  • 77.79—Excision of bone for graft from other bones

  • 78.05—Bone graft from femur

  • 78.06—Bone graft from patella

  • 78.07—Bone graft from tibia and fibula

  • 80.16—Other arthrotomy of knee

  • 80.26—Arthroscopy of knee

  • 80.46—Division of knee joint capsule, ligament, or cartilage

  • 80.76—Synovectomy of knee joint

  • 80.86—Other local excision or destruction of lesion of knee joint

  • 81.45—Other repairs of cruciate ligaments

  • 81.46—Other repairs of collateral ligaments

  • 81.47—Other repair of knee

  • 83.41—Excision of tendon for graft

  • 83.81—Tendon graft

  • 83.82—Graft of muscle or fascia

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Jain, N., Pietrobon, R., Guller, U. et al. Effect of provider volume on resource utilization for surgical procedures of the knee. Knee Surg Sports Traumatol Arthrosc 13, 302–312 (2005). https://doi.org/10.1007/s00167-004-0516-6

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  • DOI: https://doi.org/10.1007/s00167-004-0516-6

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