A California-based orthopedic surgery registry posted new data this week that takes a different approach to showing how well patients fared within one year of undergoing common, often expensive, musculoskeletal procedures at six state hospitals.
Rather than look at complication rates and the frequency with which patients have to be readmitted after surgery, the data released Wednesday by the California Joint Replacement Registry comes from surveys of patients before and after surgery, basically seeking to answer a basic question: Did the procedure work?
It's one of many efforts aimed at boosting transparency within the U.S. healthcare system.
While complications and unintended outcomes are extremely important, how well patients say they did after surgery is often the missing element, says Ernie Valente, senior director of healthcare transparency for the Pacific Business Group on Health, which funds the registry. “But the whole goal of surgery is to improve functioning for the person who elects to undergo the procedure,” he said.
The registry was started in 2010. There were 14 early adopters of the program, but results for only six of the hospitals were available for the time period evaluated—April 1, 2011, through Nov. 6, 2014.
According to the results, 88% of the patients who underwent procedures at UCSF Medical Center, San Francisco, saw “clinically meaningful” improvements. Improvement was reported by 87% of the patients surveyed at Stanford University Medical Center, Palo Alto; 86.6% at both the Hoag Orthopedic Institute, Irvine, and St. Joseph Hospital of Orange (Calif.); 86.3% at John Muir Medical Center, Walnut Creek; and 83.4% at Cedars-Sinai Medical Center, Los Angeles.
To obtain the data, patients were asked 24 specific questions about the status of the joint that needed care, like whether or not a knee-surgery patient is in pain, or was able to bend their leg, climb stairs or perform basic physical functions. They were surveyed again one year later, and researchers looked for significant post-surgical outcomes in the patients' ability to perform those functions.
Patient-reported outcomes are underused, so hospitals voluntarily reporting them “deserve kudos,” said Matt Austin, an assistant professor at the Armstrong Institute for Patient Safety and Quality at Johns Hopkins. Future efforts should include surgeon-specific data. “Having both of those data would be dynamite,” he said.
Orthopedic surgeries are among the most common procedures in the U.S. According to the Agency for Healthcare Research and Quality, five musculoskeletal procedures—knee arthroplasty, laminectomy, spinal fusion, hip replacement, and treatment of hip or lower extremity fracture or dislocation—together account for about 17% of all operating room procedures.
They also are among the most expensive, which has led to a push for expanded registries, with more basic information on the surgeries, to help providers judge performance and quality.
In November, a separate group called the American Joint Replacement Registry became the first national medical procedure registry in the U.S. It planned to include basic information on roughly 43,000 joint surgeries.