Patients from Canada who underwent total knee arthroplasty experienced a higher rate of major complications compared with patients from the United States, according to results recently published in JAMA Surgery.
Orthopedics Today, February 2016.
“In our study, it was clear that Canadian patients had a significantly longer length of stay in hospital following hip and knee arthroplasty as compared to the United States, where there was at least a 3-fold higher discharge rate to rehabilitation facilities,” John Antoniou, MD, PhD, FRCSC, told Orthopedics Today. “The rate of major complications following hip and knee arthroplasty was low in both countries; however, the odds were slightly higher in Canadian patients following knee replacement surgery.”
United States vs Canada
Using the National Surgical Quality Improvement Program (NSQIP), Antoniou and colleagues identified 55,335 patients who underwent primary elective total hip or knee arthroplasty between January 2011 and December 2012. Overall, 19,480 and 2,039 total hip arthroplasties (THAs) and 30,979 and 2,837 total knee arthroplasties (TKAs) from the United States and Canada, respectively, were included. Results showed most U.S. patients underwent general anesthesia, while more Canadian patients underwent regional anesthesia.
There were significantly higher odds ratios of major complications after TKA among patients who underwent surgery in Canada, according to a multivariable model controlling for baseline and operative characteristics. However, after accounting for all variables, researchers found no significant difference in major complications following THA between the countries.
Comparison of US and Canadian Perioperative Outcomes and Hospital Efficiency After Total Hip and Knee Arthroplasty, Hart A, Bergeron SG, Epure L, Huk O, Zukor D, Antoniou J. JAMA Surg. 2015 Oct;150(10):990-8. doi: 10.1001/jamasurg.2015.1239.
Provider volume and other predictors of outcome after total knee arthroplasty: a population study in Ontario, Kreder HJ, Grosso P, Williams JI, Jaglal S, Axcell T, Wal EK, Stephen DJ. Can J Surg. 2003 Feb;46(1):15-22.
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