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John A Baron - One of the best experts on this subject based on the ideXlab platform.

  • rates and outcomes of primary and revision total Hip Replacement in the united states medicare population
    Journal of Bone and Joint Surgery American Volume, 2003
    Co-Authors: Nizar N Mahomed, William H Harris, Jane Barrett, Jeffrey N Katz, Charlotte B Phillips, Elena Losina, Robert A Lew, Edward Guadagnoli, Robert Poss, John A Baron
    Abstract:

    Background: Information on the epidemiology of primary total Hip Replacement is limited, and we are not aware of any reports on the epidemiology of revision total Hip Replacement. The objective of this study was to characterize the rates and immediate postoperative outcomes of primary and revision total Hip Replacement in persons sixty-five years of age and older residing in the United States. Methods: We used Medicare claims submitted by hospitals, physicians, and outpatient facilities between July 1, 1995, and June 30, 1996, to identify individuals who had undergone elective primary total Hip Replacement for a reason other than a fracture (61,568 patients) or had had revision total Hip Replacement (13,483 patients). Annual incidence rates of primary and revision total Hip Replacement were calculated, and multivariate modeling was used to evaluate the association between patient characteristics and surgical rates. The rates of occurrence of five complications within ninety days postoperatively were also evaluated, and relationsHips between those outcomes and patient characteristics were assessed with use of multivariate models adjusted for hospital and surgeon volume. Results: The rates of primary total Hip Replacement were three to six times higher than the rates of revision total Hip Replacement. Women had higher rates than men, and whites had higher rates than blacks. The rates of primary and revision total Hip Replacement increased with age until the age of seventy-five to seventy-nine years and then declined. The rates of complications occurring within ninety days after primary total Hip Replacement were 1.0% for mortality, 0.9% for pulmonary embolus, 0.2% for wound infection, 4.6% for hospital readmission, and 3.1% for Hip dislocation. The rates after revision total Hip Replacement were 2.6%, 0.8%, 0.95%, 10.0%, and 8.4%, respectively. Factors associated with an increased risk of an adverse outcome included increased age, gender (men were at higher risk than women), race (blacks were at higher risk than whites), a medical comorbidity, and a low income. Conclusions: Analysis of United States Medicare population data showed that the rates of total Hip Replacement increased with age up to the age of seventy-five to seventy-nine years and that blacks had a significantly lower rate of total Hip Replacement than whites. The overall rates of adverse outcomes were relatively low, but they were significantly higher after revision than after primary total Hip Replacement. Level of Evidence: Prognostic study, Level II-1 (retrospective study). See p. 2 for complete description of levels of evidence.

  • rates and outcomes of primary and revision total Hip Replacement in the united states medicare population
    Journal of Bone and Joint Surgery American Volume, 2003
    Co-Authors: Nizar N Mahomed, William H Harris, Jane Barrett, Jeffrey N Katz, Charlotte B Phillips, Elena Losina, Edward Guadagnoli, Robert Poss, John A Baron
    Abstract:

    Background: Information on the epidemiology of primary total Hip Replacement is limited, and we are not aware of any reports on the epidemiology of revision total Hip Replacement. The objective of this study was to characterize the rates and immediate postoperative outcomes of primary and revision total Hip Replacement in persons sixty-five years of age and older residing in the United States. Methods: We used Medicare claims submitted by hospitals, physicians, and outpatient facilities between July 1, 1995, and June 30, 1996, to identify individuals who had undergone elective primary total Hip Replacement for a reason other than a fracture (61,568 patients) or had had revision total Hip Replacement (13,483 patients). Annual incidence rates of primary and revision total Hip Replacement were calculated, and multivariate modeling was used to evaluate the association between patient characteristics and surgical rates. The rates of occurrence of five complications within ninety days postoperatively were also evaluated, and relationsHips between those outcomes and patient characteristics were assessed with use of multivariate models adjusted for hospital and surgeon volume. Results: The rates of primary total Hip Replacement were three to six times higher than the rates of revision total Hip Replacement. Women had higher rates than men, and whites had higher rates than blacks. The rates of primary and revision total Hip Replacement increased with age until the age of seventy-five to seventy-nine years and then declined. The rates of complications occurring within ninety days after primary total Hip Replacement were 1.0% for mortality, 0.9% for pulmonary embolus, 0.2% for wound infection, 4.6% for hospital readmission, and 3.1% for Hip dislocation. The rates after revision total Hip Replacement were 2.6%, 0.8%, 0.95%, 10.0%, and 8.4%, respectively. Factors associated with an increased risk of an adverse outcome included increased age, gender (men were at higher risk than women), race (blacks were at higher risk than whites), a medical comorbidity, and a low income. Conclusions: Analysis of United States Medicare population data showed that the rates of total Hip Replacement increased with age up to the age of seventy-five to seventy-nine years and that blacks had a significantly lower rate of total Hip Replacement than whites. The overall rates of adverse outcomes were relatively low, but they were significantly higher after revision than after primary total Hip Replacement. Level of Evidence: Prognostic study, Level II-1 (retrospective study). See p. 2 for complete description of levels of evidence.

  • incidence rates of dislocation pulmonary embolism and deep infection during the first six months after elective total Hip Replacement
    Journal of Bone and Joint Surgery American Volume, 2003
    Co-Authors: Charlotte B Phillips, William H Harris, Nizar N Mahomed, Jane Barrett, Elena Losina, Edward Guadagnoli, John A Baron, Elizabeth A Lingard
    Abstract:

    Background: The lengths of acute hospital stays following total Hip Replacement have diminished substantially in recent years. As a result, a greater proportion of complications occurs following discharge. Data on the incidence trends of major complications of total Hip Replacement would facilitate recognition and management of these adverse events. Methods: We used Medicare claims data on beneficiaries sixty-five years and older who had had elective, primary total Hip Replacement for a reason other than a fracture (58,521 patients) or had had revision total Hip Replacement (12,956 patients) between July 1, 1995, and June 30, 1996. We calculated incidence rates of dislocation, pulmonary embolism, and deep Hip infection per 10,000 person-weeks for four time-periods following the admission for the surgery (during the index hospitalization, from discharge to four weeks postoperatively, from five to thirteen weeks postoperatively, and from fourteen to twenty-six weeks postoperatively). We then used life-table methods to estimate the cumulative incidence of each complication over the first six postoperative months. Results: Of the patients who had had a primary total Hip Replacement, 3.9% had a dislocation, 0.9% had a pulmonary embolism, and 0.2% had a deep infection in the first twenty-six postoperative weeks. In the revision total Hip Replacement cohort, the proportions with dislocation, pulmonary embolism, and deep infection were 14.4%, 0.8%, and 1.1%, respectively. The rates of these adverse outcomes were highest during the index hospitalization, diminished considerably in the period from discharge to four weeks postoperatively, and continued to drop in the periods from five to thirteen and fourteen to twenty-six weeks postoperatively. Conclusions: The incidence rates of dislocation, pulmonary embolism, and deep infection are highest immediately after total Hip Replacement, but they continue to be elevated throughout the first three postoperative months. With the lengths of hospital stays continuing to diminish, an increasing proportion of complications will occur in outpatients. These findings provide a basis for developing strategies to prevent these complications in the postdischarge management of patients who have had elective total Hip Replacement. Level of Evidence: Prognostic study, Level II-1 (retrospective study). See p. 2 for complete description of levels of evidence.

  • association between hospital and surgeon procedure volume and outcomes of total Hip Replacement in the united states medicare population
    Journal of Bone and Joint Surgery American Volume, 2001
    Co-Authors: Jeffrey N Katz, William H Harris, Nizar N Mahomed, Jane Barrett, Charlotte B Phillips, Elena Losina, Robert A Lew, Edward Guadagnoli, Robert Poss, John A Baron
    Abstract:

    Background: The mortality and complication rates of many surgical procedures are inversely related to hospital procedure volume. The objective of this study was to determine whether the volumes of primary and revision total Hip Replacements performed at hospitals and by surgeons are associated with rates of mortality and complications. Methods: We analyzed claims data of Medicare recipients who underwent elective primary total Hip Replacement (58,521 procedures) or revision total Hip Replacement (12,956 procedures) between July 1995 and June 1996. We assessed the relationsHip between surgeon and hospital procedure volume and mortality, dislocation, deep infection, and pulmonary embolus in the first ninety days postoperatively. Analyses were adjusted for age, gender, arthritis diagnosis, comorbid conditions, and income. Analyses of hospital volume were adjusted for surgeon volume, and analyses of surgeon volume were adjusted for hospital volume. Results: Twelve percent of all primary total Hip Replacements and 49% of all revisions were performed in centers in which ten or fewer of these procedures were carried out in the Medicare population annually. In addition, 52% of the primary total Hip Replacements and 77% of the revisions were performed by surgeons who carried out ten or fewer of these procedures annually. Patients treated with primary total Hip Replacement in hospitals in which more than 100 of the procedures were performed per year had a lower risk of death than those treated with primary Replacement in hospitals in which ten or fewer procedures were performed per year (mortality rate, 0.7% compared with 1.3%; adjusted odds ratio, 0.58; 95% confidence interval, 0.38, 0.89). Patients treated with primary total Hip Replacement by surgeons who performed more than fifty of those procedures in Medicare beneficiaries per year had a lower risk of dislocation than those who were treated by surgeons who performed five or fewer of the procedures per year (dislocation rate, 1.5% compared with 4.2%; adjusted odds ratio, 0.49; 95% confidence interval, 0.34, 0.69). Patients who had revision total Hip Replacement done by surgeons who performed more than ten such procedures per year had a lower rate of mortality than patients who were treated by surgeons who performed three or fewer of the procedures per year (mortality rate, 1.5% compared with 3.1%; adjusted odds ratio, 0.65; 95% confidence interval, 0.44, 0.96). Conclusions: Patients treated at hospitals and by surgeons with higher annual caseloads of primary and revision total Hip Replacement had lower rates of mortality and of selected complications. These analyses of Medicare claims are limited by a lack of key clinical information such as operative details and preoperative functional status.

William H Harris - One of the best experts on this subject based on the ideXlab platform.

  • rates and outcomes of primary and revision total Hip Replacement in the united states medicare population
    Journal of Bone and Joint Surgery American Volume, 2003
    Co-Authors: Nizar N Mahomed, William H Harris, Jane Barrett, Jeffrey N Katz, Charlotte B Phillips, Elena Losina, Edward Guadagnoli, Robert Poss, John A Baron
    Abstract:

    Background: Information on the epidemiology of primary total Hip Replacement is limited, and we are not aware of any reports on the epidemiology of revision total Hip Replacement. The objective of this study was to characterize the rates and immediate postoperative outcomes of primary and revision total Hip Replacement in persons sixty-five years of age and older residing in the United States. Methods: We used Medicare claims submitted by hospitals, physicians, and outpatient facilities between July 1, 1995, and June 30, 1996, to identify individuals who had undergone elective primary total Hip Replacement for a reason other than a fracture (61,568 patients) or had had revision total Hip Replacement (13,483 patients). Annual incidence rates of primary and revision total Hip Replacement were calculated, and multivariate modeling was used to evaluate the association between patient characteristics and surgical rates. The rates of occurrence of five complications within ninety days postoperatively were also evaluated, and relationsHips between those outcomes and patient characteristics were assessed with use of multivariate models adjusted for hospital and surgeon volume. Results: The rates of primary total Hip Replacement were three to six times higher than the rates of revision total Hip Replacement. Women had higher rates than men, and whites had higher rates than blacks. The rates of primary and revision total Hip Replacement increased with age until the age of seventy-five to seventy-nine years and then declined. The rates of complications occurring within ninety days after primary total Hip Replacement were 1.0% for mortality, 0.9% for pulmonary embolus, 0.2% for wound infection, 4.6% for hospital readmission, and 3.1% for Hip dislocation. The rates after revision total Hip Replacement were 2.6%, 0.8%, 0.95%, 10.0%, and 8.4%, respectively. Factors associated with an increased risk of an adverse outcome included increased age, gender (men were at higher risk than women), race (blacks were at higher risk than whites), a medical comorbidity, and a low income. Conclusions: Analysis of United States Medicare population data showed that the rates of total Hip Replacement increased with age up to the age of seventy-five to seventy-nine years and that blacks had a significantly lower rate of total Hip Replacement than whites. The overall rates of adverse outcomes were relatively low, but they were significantly higher after revision than after primary total Hip Replacement. Level of Evidence: Prognostic study, Level II-1 (retrospective study). See p. 2 for complete description of levels of evidence.

  • rates and outcomes of primary and revision total Hip Replacement in the united states medicare population
    Journal of Bone and Joint Surgery American Volume, 2003
    Co-Authors: Nizar N Mahomed, William H Harris, Jane Barrett, Jeffrey N Katz, Charlotte B Phillips, Elena Losina, Robert A Lew, Edward Guadagnoli, Robert Poss, John A Baron
    Abstract:

    Background: Information on the epidemiology of primary total Hip Replacement is limited, and we are not aware of any reports on the epidemiology of revision total Hip Replacement. The objective of this study was to characterize the rates and immediate postoperative outcomes of primary and revision total Hip Replacement in persons sixty-five years of age and older residing in the United States. Methods: We used Medicare claims submitted by hospitals, physicians, and outpatient facilities between July 1, 1995, and June 30, 1996, to identify individuals who had undergone elective primary total Hip Replacement for a reason other than a fracture (61,568 patients) or had had revision total Hip Replacement (13,483 patients). Annual incidence rates of primary and revision total Hip Replacement were calculated, and multivariate modeling was used to evaluate the association between patient characteristics and surgical rates. The rates of occurrence of five complications within ninety days postoperatively were also evaluated, and relationsHips between those outcomes and patient characteristics were assessed with use of multivariate models adjusted for hospital and surgeon volume. Results: The rates of primary total Hip Replacement were three to six times higher than the rates of revision total Hip Replacement. Women had higher rates than men, and whites had higher rates than blacks. The rates of primary and revision total Hip Replacement increased with age until the age of seventy-five to seventy-nine years and then declined. The rates of complications occurring within ninety days after primary total Hip Replacement were 1.0% for mortality, 0.9% for pulmonary embolus, 0.2% for wound infection, 4.6% for hospital readmission, and 3.1% for Hip dislocation. The rates after revision total Hip Replacement were 2.6%, 0.8%, 0.95%, 10.0%, and 8.4%, respectively. Factors associated with an increased risk of an adverse outcome included increased age, gender (men were at higher risk than women), race (blacks were at higher risk than whites), a medical comorbidity, and a low income. Conclusions: Analysis of United States Medicare population data showed that the rates of total Hip Replacement increased with age up to the age of seventy-five to seventy-nine years and that blacks had a significantly lower rate of total Hip Replacement than whites. The overall rates of adverse outcomes were relatively low, but they were significantly higher after revision than after primary total Hip Replacement. Level of Evidence: Prognostic study, Level II-1 (retrospective study). See p. 2 for complete description of levels of evidence.

  • incidence rates of dislocation pulmonary embolism and deep infection during the first six months after elective total Hip Replacement
    Journal of Bone and Joint Surgery American Volume, 2003
    Co-Authors: Charlotte B Phillips, William H Harris, Nizar N Mahomed, Jane Barrett, Elena Losina, Edward Guadagnoli, John A Baron, Elizabeth A Lingard
    Abstract:

    Background: The lengths of acute hospital stays following total Hip Replacement have diminished substantially in recent years. As a result, a greater proportion of complications occurs following discharge. Data on the incidence trends of major complications of total Hip Replacement would facilitate recognition and management of these adverse events. Methods: We used Medicare claims data on beneficiaries sixty-five years and older who had had elective, primary total Hip Replacement for a reason other than a fracture (58,521 patients) or had had revision total Hip Replacement (12,956 patients) between July 1, 1995, and June 30, 1996. We calculated incidence rates of dislocation, pulmonary embolism, and deep Hip infection per 10,000 person-weeks for four time-periods following the admission for the surgery (during the index hospitalization, from discharge to four weeks postoperatively, from five to thirteen weeks postoperatively, and from fourteen to twenty-six weeks postoperatively). We then used life-table methods to estimate the cumulative incidence of each complication over the first six postoperative months. Results: Of the patients who had had a primary total Hip Replacement, 3.9% had a dislocation, 0.9% had a pulmonary embolism, and 0.2% had a deep infection in the first twenty-six postoperative weeks. In the revision total Hip Replacement cohort, the proportions with dislocation, pulmonary embolism, and deep infection were 14.4%, 0.8%, and 1.1%, respectively. The rates of these adverse outcomes were highest during the index hospitalization, diminished considerably in the period from discharge to four weeks postoperatively, and continued to drop in the periods from five to thirteen and fourteen to twenty-six weeks postoperatively. Conclusions: The incidence rates of dislocation, pulmonary embolism, and deep infection are highest immediately after total Hip Replacement, but they continue to be elevated throughout the first three postoperative months. With the lengths of hospital stays continuing to diminish, an increasing proportion of complications will occur in outpatients. These findings provide a basis for developing strategies to prevent these complications in the postdischarge management of patients who have had elective total Hip Replacement. Level of Evidence: Prognostic study, Level II-1 (retrospective study). See p. 2 for complete description of levels of evidence.

  • association between hospital and surgeon procedure volume and outcomes of total Hip Replacement in the united states medicare population
    Journal of Bone and Joint Surgery American Volume, 2001
    Co-Authors: Jeffrey N Katz, William H Harris, Nizar N Mahomed, Jane Barrett, Charlotte B Phillips, Elena Losina, Robert A Lew, Edward Guadagnoli, Robert Poss, John A Baron
    Abstract:

    Background: The mortality and complication rates of many surgical procedures are inversely related to hospital procedure volume. The objective of this study was to determine whether the volumes of primary and revision total Hip Replacements performed at hospitals and by surgeons are associated with rates of mortality and complications. Methods: We analyzed claims data of Medicare recipients who underwent elective primary total Hip Replacement (58,521 procedures) or revision total Hip Replacement (12,956 procedures) between July 1995 and June 1996. We assessed the relationsHip between surgeon and hospital procedure volume and mortality, dislocation, deep infection, and pulmonary embolus in the first ninety days postoperatively. Analyses were adjusted for age, gender, arthritis diagnosis, comorbid conditions, and income. Analyses of hospital volume were adjusted for surgeon volume, and analyses of surgeon volume were adjusted for hospital volume. Results: Twelve percent of all primary total Hip Replacements and 49% of all revisions were performed in centers in which ten or fewer of these procedures were carried out in the Medicare population annually. In addition, 52% of the primary total Hip Replacements and 77% of the revisions were performed by surgeons who carried out ten or fewer of these procedures annually. Patients treated with primary total Hip Replacement in hospitals in which more than 100 of the procedures were performed per year had a lower risk of death than those treated with primary Replacement in hospitals in which ten or fewer procedures were performed per year (mortality rate, 0.7% compared with 1.3%; adjusted odds ratio, 0.58; 95% confidence interval, 0.38, 0.89). Patients treated with primary total Hip Replacement by surgeons who performed more than fifty of those procedures in Medicare beneficiaries per year had a lower risk of dislocation than those who were treated by surgeons who performed five or fewer of the procedures per year (dislocation rate, 1.5% compared with 4.2%; adjusted odds ratio, 0.49; 95% confidence interval, 0.34, 0.69). Patients who had revision total Hip Replacement done by surgeons who performed more than ten such procedures per year had a lower rate of mortality than patients who were treated by surgeons who performed three or fewer of the procedures per year (mortality rate, 1.5% compared with 3.1%; adjusted odds ratio, 0.65; 95% confidence interval, 0.44, 0.96). Conclusions: Patients treated at hospitals and by surgeons with higher annual caseloads of primary and revision total Hip Replacement had lower rates of mortality and of selected complications. These analyses of Medicare claims are limited by a lack of key clinical information such as operative details and preoperative functional status.

  • osteolysis and particle disease in Hip Replacement a review
    Acta Orthopaedica Scandinavica, 1994
    Co-Authors: William H Harris
    Abstract:

    Much can be learned from a careful reassessment of the history of total Hip Replacement over the past 35 years. Such a review is revealing about certain aspects of the nature of medical science, and most importantly, about solving our current problems in total Hip Replacement, notably cementless surgery with the rapidly increasing incidence of major pelvic and femoral lysis, predominantly manifest after 5 years or so postoperatively.

Nizar N Mahomed - One of the best experts on this subject based on the ideXlab platform.

  • rates and outcomes of primary and revision total Hip Replacement in the united states medicare population
    Journal of Bone and Joint Surgery American Volume, 2003
    Co-Authors: Nizar N Mahomed, William H Harris, Jane Barrett, Jeffrey N Katz, Charlotte B Phillips, Elena Losina, Robert A Lew, Edward Guadagnoli, Robert Poss, John A Baron
    Abstract:

    Background: Information on the epidemiology of primary total Hip Replacement is limited, and we are not aware of any reports on the epidemiology of revision total Hip Replacement. The objective of this study was to characterize the rates and immediate postoperative outcomes of primary and revision total Hip Replacement in persons sixty-five years of age and older residing in the United States. Methods: We used Medicare claims submitted by hospitals, physicians, and outpatient facilities between July 1, 1995, and June 30, 1996, to identify individuals who had undergone elective primary total Hip Replacement for a reason other than a fracture (61,568 patients) or had had revision total Hip Replacement (13,483 patients). Annual incidence rates of primary and revision total Hip Replacement were calculated, and multivariate modeling was used to evaluate the association between patient characteristics and surgical rates. The rates of occurrence of five complications within ninety days postoperatively were also evaluated, and relationsHips between those outcomes and patient characteristics were assessed with use of multivariate models adjusted for hospital and surgeon volume. Results: The rates of primary total Hip Replacement were three to six times higher than the rates of revision total Hip Replacement. Women had higher rates than men, and whites had higher rates than blacks. The rates of primary and revision total Hip Replacement increased with age until the age of seventy-five to seventy-nine years and then declined. The rates of complications occurring within ninety days after primary total Hip Replacement were 1.0% for mortality, 0.9% for pulmonary embolus, 0.2% for wound infection, 4.6% for hospital readmission, and 3.1% for Hip dislocation. The rates after revision total Hip Replacement were 2.6%, 0.8%, 0.95%, 10.0%, and 8.4%, respectively. Factors associated with an increased risk of an adverse outcome included increased age, gender (men were at higher risk than women), race (blacks were at higher risk than whites), a medical comorbidity, and a low income. Conclusions: Analysis of United States Medicare population data showed that the rates of total Hip Replacement increased with age up to the age of seventy-five to seventy-nine years and that blacks had a significantly lower rate of total Hip Replacement than whites. The overall rates of adverse outcomes were relatively low, but they were significantly higher after revision than after primary total Hip Replacement. Level of Evidence: Prognostic study, Level II-1 (retrospective study). See p. 2 for complete description of levels of evidence.

  • rates and outcomes of primary and revision total Hip Replacement in the united states medicare population
    Journal of Bone and Joint Surgery American Volume, 2003
    Co-Authors: Nizar N Mahomed, William H Harris, Jane Barrett, Jeffrey N Katz, Charlotte B Phillips, Elena Losina, Edward Guadagnoli, Robert Poss, John A Baron
    Abstract:

    Background: Information on the epidemiology of primary total Hip Replacement is limited, and we are not aware of any reports on the epidemiology of revision total Hip Replacement. The objective of this study was to characterize the rates and immediate postoperative outcomes of primary and revision total Hip Replacement in persons sixty-five years of age and older residing in the United States. Methods: We used Medicare claims submitted by hospitals, physicians, and outpatient facilities between July 1, 1995, and June 30, 1996, to identify individuals who had undergone elective primary total Hip Replacement for a reason other than a fracture (61,568 patients) or had had revision total Hip Replacement (13,483 patients). Annual incidence rates of primary and revision total Hip Replacement were calculated, and multivariate modeling was used to evaluate the association between patient characteristics and surgical rates. The rates of occurrence of five complications within ninety days postoperatively were also evaluated, and relationsHips between those outcomes and patient characteristics were assessed with use of multivariate models adjusted for hospital and surgeon volume. Results: The rates of primary total Hip Replacement were three to six times higher than the rates of revision total Hip Replacement. Women had higher rates than men, and whites had higher rates than blacks. The rates of primary and revision total Hip Replacement increased with age until the age of seventy-five to seventy-nine years and then declined. The rates of complications occurring within ninety days after primary total Hip Replacement were 1.0% for mortality, 0.9% for pulmonary embolus, 0.2% for wound infection, 4.6% for hospital readmission, and 3.1% for Hip dislocation. The rates after revision total Hip Replacement were 2.6%, 0.8%, 0.95%, 10.0%, and 8.4%, respectively. Factors associated with an increased risk of an adverse outcome included increased age, gender (men were at higher risk than women), race (blacks were at higher risk than whites), a medical comorbidity, and a low income. Conclusions: Analysis of United States Medicare population data showed that the rates of total Hip Replacement increased with age up to the age of seventy-five to seventy-nine years and that blacks had a significantly lower rate of total Hip Replacement than whites. The overall rates of adverse outcomes were relatively low, but they were significantly higher after revision than after primary total Hip Replacement. Level of Evidence: Prognostic study, Level II-1 (retrospective study). See p. 2 for complete description of levels of evidence.

  • incidence rates of dislocation pulmonary embolism and deep infection during the first six months after elective total Hip Replacement
    Journal of Bone and Joint Surgery American Volume, 2003
    Co-Authors: Charlotte B Phillips, William H Harris, Nizar N Mahomed, Jane Barrett, Elena Losina, Edward Guadagnoli, John A Baron, Elizabeth A Lingard
    Abstract:

    Background: The lengths of acute hospital stays following total Hip Replacement have diminished substantially in recent years. As a result, a greater proportion of complications occurs following discharge. Data on the incidence trends of major complications of total Hip Replacement would facilitate recognition and management of these adverse events. Methods: We used Medicare claims data on beneficiaries sixty-five years and older who had had elective, primary total Hip Replacement for a reason other than a fracture (58,521 patients) or had had revision total Hip Replacement (12,956 patients) between July 1, 1995, and June 30, 1996. We calculated incidence rates of dislocation, pulmonary embolism, and deep Hip infection per 10,000 person-weeks for four time-periods following the admission for the surgery (during the index hospitalization, from discharge to four weeks postoperatively, from five to thirteen weeks postoperatively, and from fourteen to twenty-six weeks postoperatively). We then used life-table methods to estimate the cumulative incidence of each complication over the first six postoperative months. Results: Of the patients who had had a primary total Hip Replacement, 3.9% had a dislocation, 0.9% had a pulmonary embolism, and 0.2% had a deep infection in the first twenty-six postoperative weeks. In the revision total Hip Replacement cohort, the proportions with dislocation, pulmonary embolism, and deep infection were 14.4%, 0.8%, and 1.1%, respectively. The rates of these adverse outcomes were highest during the index hospitalization, diminished considerably in the period from discharge to four weeks postoperatively, and continued to drop in the periods from five to thirteen and fourteen to twenty-six weeks postoperatively. Conclusions: The incidence rates of dislocation, pulmonary embolism, and deep infection are highest immediately after total Hip Replacement, but they continue to be elevated throughout the first three postoperative months. With the lengths of hospital stays continuing to diminish, an increasing proportion of complications will occur in outpatients. These findings provide a basis for developing strategies to prevent these complications in the postdischarge management of patients who have had elective total Hip Replacement. Level of Evidence: Prognostic study, Level II-1 (retrospective study). See p. 2 for complete description of levels of evidence.

  • association between hospital and surgeon procedure volume and outcomes of total Hip Replacement in the united states medicare population
    Journal of Bone and Joint Surgery American Volume, 2001
    Co-Authors: Jeffrey N Katz, William H Harris, Nizar N Mahomed, Jane Barrett, Charlotte B Phillips, Elena Losina, Robert A Lew, Edward Guadagnoli, Robert Poss, John A Baron
    Abstract:

    Background: The mortality and complication rates of many surgical procedures are inversely related to hospital procedure volume. The objective of this study was to determine whether the volumes of primary and revision total Hip Replacements performed at hospitals and by surgeons are associated with rates of mortality and complications. Methods: We analyzed claims data of Medicare recipients who underwent elective primary total Hip Replacement (58,521 procedures) or revision total Hip Replacement (12,956 procedures) between July 1995 and June 1996. We assessed the relationsHip between surgeon and hospital procedure volume and mortality, dislocation, deep infection, and pulmonary embolus in the first ninety days postoperatively. Analyses were adjusted for age, gender, arthritis diagnosis, comorbid conditions, and income. Analyses of hospital volume were adjusted for surgeon volume, and analyses of surgeon volume were adjusted for hospital volume. Results: Twelve percent of all primary total Hip Replacements and 49% of all revisions were performed in centers in which ten or fewer of these procedures were carried out in the Medicare population annually. In addition, 52% of the primary total Hip Replacements and 77% of the revisions were performed by surgeons who carried out ten or fewer of these procedures annually. Patients treated with primary total Hip Replacement in hospitals in which more than 100 of the procedures were performed per year had a lower risk of death than those treated with primary Replacement in hospitals in which ten or fewer procedures were performed per year (mortality rate, 0.7% compared with 1.3%; adjusted odds ratio, 0.58; 95% confidence interval, 0.38, 0.89). Patients treated with primary total Hip Replacement by surgeons who performed more than fifty of those procedures in Medicare beneficiaries per year had a lower risk of dislocation than those who were treated by surgeons who performed five or fewer of the procedures per year (dislocation rate, 1.5% compared with 4.2%; adjusted odds ratio, 0.49; 95% confidence interval, 0.34, 0.69). Patients who had revision total Hip Replacement done by surgeons who performed more than ten such procedures per year had a lower rate of mortality than patients who were treated by surgeons who performed three or fewer of the procedures per year (mortality rate, 1.5% compared with 3.1%; adjusted odds ratio, 0.65; 95% confidence interval, 0.44, 0.96). Conclusions: Patients treated at hospitals and by surgeons with higher annual caseloads of primary and revision total Hip Replacement had lower rates of mortality and of selected complications. These analyses of Medicare claims are limited by a lack of key clinical information such as operative details and preoperative functional status.

Edward Guadagnoli - One of the best experts on this subject based on the ideXlab platform.

  • rates and outcomes of primary and revision total Hip Replacement in the united states medicare population
    Journal of Bone and Joint Surgery American Volume, 2003
    Co-Authors: Nizar N Mahomed, William H Harris, Jane Barrett, Jeffrey N Katz, Charlotte B Phillips, Elena Losina, Robert A Lew, Edward Guadagnoli, Robert Poss, John A Baron
    Abstract:

    Background: Information on the epidemiology of primary total Hip Replacement is limited, and we are not aware of any reports on the epidemiology of revision total Hip Replacement. The objective of this study was to characterize the rates and immediate postoperative outcomes of primary and revision total Hip Replacement in persons sixty-five years of age and older residing in the United States. Methods: We used Medicare claims submitted by hospitals, physicians, and outpatient facilities between July 1, 1995, and June 30, 1996, to identify individuals who had undergone elective primary total Hip Replacement for a reason other than a fracture (61,568 patients) or had had revision total Hip Replacement (13,483 patients). Annual incidence rates of primary and revision total Hip Replacement were calculated, and multivariate modeling was used to evaluate the association between patient characteristics and surgical rates. The rates of occurrence of five complications within ninety days postoperatively were also evaluated, and relationsHips between those outcomes and patient characteristics were assessed with use of multivariate models adjusted for hospital and surgeon volume. Results: The rates of primary total Hip Replacement were three to six times higher than the rates of revision total Hip Replacement. Women had higher rates than men, and whites had higher rates than blacks. The rates of primary and revision total Hip Replacement increased with age until the age of seventy-five to seventy-nine years and then declined. The rates of complications occurring within ninety days after primary total Hip Replacement were 1.0% for mortality, 0.9% for pulmonary embolus, 0.2% for wound infection, 4.6% for hospital readmission, and 3.1% for Hip dislocation. The rates after revision total Hip Replacement were 2.6%, 0.8%, 0.95%, 10.0%, and 8.4%, respectively. Factors associated with an increased risk of an adverse outcome included increased age, gender (men were at higher risk than women), race (blacks were at higher risk than whites), a medical comorbidity, and a low income. Conclusions: Analysis of United States Medicare population data showed that the rates of total Hip Replacement increased with age up to the age of seventy-five to seventy-nine years and that blacks had a significantly lower rate of total Hip Replacement than whites. The overall rates of adverse outcomes were relatively low, but they were significantly higher after revision than after primary total Hip Replacement. Level of Evidence: Prognostic study, Level II-1 (retrospective study). See p. 2 for complete description of levels of evidence.

  • rates and outcomes of primary and revision total Hip Replacement in the united states medicare population
    Journal of Bone and Joint Surgery American Volume, 2003
    Co-Authors: Nizar N Mahomed, William H Harris, Jane Barrett, Jeffrey N Katz, Charlotte B Phillips, Elena Losina, Edward Guadagnoli, Robert Poss, John A Baron
    Abstract:

    Background: Information on the epidemiology of primary total Hip Replacement is limited, and we are not aware of any reports on the epidemiology of revision total Hip Replacement. The objective of this study was to characterize the rates and immediate postoperative outcomes of primary and revision total Hip Replacement in persons sixty-five years of age and older residing in the United States. Methods: We used Medicare claims submitted by hospitals, physicians, and outpatient facilities between July 1, 1995, and June 30, 1996, to identify individuals who had undergone elective primary total Hip Replacement for a reason other than a fracture (61,568 patients) or had had revision total Hip Replacement (13,483 patients). Annual incidence rates of primary and revision total Hip Replacement were calculated, and multivariate modeling was used to evaluate the association between patient characteristics and surgical rates. The rates of occurrence of five complications within ninety days postoperatively were also evaluated, and relationsHips between those outcomes and patient characteristics were assessed with use of multivariate models adjusted for hospital and surgeon volume. Results: The rates of primary total Hip Replacement were three to six times higher than the rates of revision total Hip Replacement. Women had higher rates than men, and whites had higher rates than blacks. The rates of primary and revision total Hip Replacement increased with age until the age of seventy-five to seventy-nine years and then declined. The rates of complications occurring within ninety days after primary total Hip Replacement were 1.0% for mortality, 0.9% for pulmonary embolus, 0.2% for wound infection, 4.6% for hospital readmission, and 3.1% for Hip dislocation. The rates after revision total Hip Replacement were 2.6%, 0.8%, 0.95%, 10.0%, and 8.4%, respectively. Factors associated with an increased risk of an adverse outcome included increased age, gender (men were at higher risk than women), race (blacks were at higher risk than whites), a medical comorbidity, and a low income. Conclusions: Analysis of United States Medicare population data showed that the rates of total Hip Replacement increased with age up to the age of seventy-five to seventy-nine years and that blacks had a significantly lower rate of total Hip Replacement than whites. The overall rates of adverse outcomes were relatively low, but they were significantly higher after revision than after primary total Hip Replacement. Level of Evidence: Prognostic study, Level II-1 (retrospective study). See p. 2 for complete description of levels of evidence.

  • incidence rates of dislocation pulmonary embolism and deep infection during the first six months after elective total Hip Replacement
    Journal of Bone and Joint Surgery American Volume, 2003
    Co-Authors: Charlotte B Phillips, William H Harris, Nizar N Mahomed, Jane Barrett, Elena Losina, Edward Guadagnoli, John A Baron, Elizabeth A Lingard
    Abstract:

    Background: The lengths of acute hospital stays following total Hip Replacement have diminished substantially in recent years. As a result, a greater proportion of complications occurs following discharge. Data on the incidence trends of major complications of total Hip Replacement would facilitate recognition and management of these adverse events. Methods: We used Medicare claims data on beneficiaries sixty-five years and older who had had elective, primary total Hip Replacement for a reason other than a fracture (58,521 patients) or had had revision total Hip Replacement (12,956 patients) between July 1, 1995, and June 30, 1996. We calculated incidence rates of dislocation, pulmonary embolism, and deep Hip infection per 10,000 person-weeks for four time-periods following the admission for the surgery (during the index hospitalization, from discharge to four weeks postoperatively, from five to thirteen weeks postoperatively, and from fourteen to twenty-six weeks postoperatively). We then used life-table methods to estimate the cumulative incidence of each complication over the first six postoperative months. Results: Of the patients who had had a primary total Hip Replacement, 3.9% had a dislocation, 0.9% had a pulmonary embolism, and 0.2% had a deep infection in the first twenty-six postoperative weeks. In the revision total Hip Replacement cohort, the proportions with dislocation, pulmonary embolism, and deep infection were 14.4%, 0.8%, and 1.1%, respectively. The rates of these adverse outcomes were highest during the index hospitalization, diminished considerably in the period from discharge to four weeks postoperatively, and continued to drop in the periods from five to thirteen and fourteen to twenty-six weeks postoperatively. Conclusions: The incidence rates of dislocation, pulmonary embolism, and deep infection are highest immediately after total Hip Replacement, but they continue to be elevated throughout the first three postoperative months. With the lengths of hospital stays continuing to diminish, an increasing proportion of complications will occur in outpatients. These findings provide a basis for developing strategies to prevent these complications in the postdischarge management of patients who have had elective total Hip Replacement. Level of Evidence: Prognostic study, Level II-1 (retrospective study). See p. 2 for complete description of levels of evidence.

  • association between hospital and surgeon procedure volume and outcomes of total Hip Replacement in the united states medicare population
    Journal of Bone and Joint Surgery American Volume, 2001
    Co-Authors: Jeffrey N Katz, William H Harris, Nizar N Mahomed, Jane Barrett, Charlotte B Phillips, Elena Losina, Robert A Lew, Edward Guadagnoli, Robert Poss, John A Baron
    Abstract:

    Background: The mortality and complication rates of many surgical procedures are inversely related to hospital procedure volume. The objective of this study was to determine whether the volumes of primary and revision total Hip Replacements performed at hospitals and by surgeons are associated with rates of mortality and complications. Methods: We analyzed claims data of Medicare recipients who underwent elective primary total Hip Replacement (58,521 procedures) or revision total Hip Replacement (12,956 procedures) between July 1995 and June 1996. We assessed the relationsHip between surgeon and hospital procedure volume and mortality, dislocation, deep infection, and pulmonary embolus in the first ninety days postoperatively. Analyses were adjusted for age, gender, arthritis diagnosis, comorbid conditions, and income. Analyses of hospital volume were adjusted for surgeon volume, and analyses of surgeon volume were adjusted for hospital volume. Results: Twelve percent of all primary total Hip Replacements and 49% of all revisions were performed in centers in which ten or fewer of these procedures were carried out in the Medicare population annually. In addition, 52% of the primary total Hip Replacements and 77% of the revisions were performed by surgeons who carried out ten or fewer of these procedures annually. Patients treated with primary total Hip Replacement in hospitals in which more than 100 of the procedures were performed per year had a lower risk of death than those treated with primary Replacement in hospitals in which ten or fewer procedures were performed per year (mortality rate, 0.7% compared with 1.3%; adjusted odds ratio, 0.58; 95% confidence interval, 0.38, 0.89). Patients treated with primary total Hip Replacement by surgeons who performed more than fifty of those procedures in Medicare beneficiaries per year had a lower risk of dislocation than those who were treated by surgeons who performed five or fewer of the procedures per year (dislocation rate, 1.5% compared with 4.2%; adjusted odds ratio, 0.49; 95% confidence interval, 0.34, 0.69). Patients who had revision total Hip Replacement done by surgeons who performed more than ten such procedures per year had a lower rate of mortality than patients who were treated by surgeons who performed three or fewer of the procedures per year (mortality rate, 1.5% compared with 3.1%; adjusted odds ratio, 0.65; 95% confidence interval, 0.44, 0.96). Conclusions: Patients treated at hospitals and by surgeons with higher annual caseloads of primary and revision total Hip Replacement had lower rates of mortality and of selected complications. These analyses of Medicare claims are limited by a lack of key clinical information such as operative details and preoperative functional status.

Charlotte B Phillips - One of the best experts on this subject based on the ideXlab platform.

  • rates and outcomes of primary and revision total Hip Replacement in the united states medicare population
    Journal of Bone and Joint Surgery American Volume, 2003
    Co-Authors: Nizar N Mahomed, William H Harris, Jane Barrett, Jeffrey N Katz, Charlotte B Phillips, Elena Losina, Robert A Lew, Edward Guadagnoli, Robert Poss, John A Baron
    Abstract:

    Background: Information on the epidemiology of primary total Hip Replacement is limited, and we are not aware of any reports on the epidemiology of revision total Hip Replacement. The objective of this study was to characterize the rates and immediate postoperative outcomes of primary and revision total Hip Replacement in persons sixty-five years of age and older residing in the United States. Methods: We used Medicare claims submitted by hospitals, physicians, and outpatient facilities between July 1, 1995, and June 30, 1996, to identify individuals who had undergone elective primary total Hip Replacement for a reason other than a fracture (61,568 patients) or had had revision total Hip Replacement (13,483 patients). Annual incidence rates of primary and revision total Hip Replacement were calculated, and multivariate modeling was used to evaluate the association between patient characteristics and surgical rates. The rates of occurrence of five complications within ninety days postoperatively were also evaluated, and relationsHips between those outcomes and patient characteristics were assessed with use of multivariate models adjusted for hospital and surgeon volume. Results: The rates of primary total Hip Replacement were three to six times higher than the rates of revision total Hip Replacement. Women had higher rates than men, and whites had higher rates than blacks. The rates of primary and revision total Hip Replacement increased with age until the age of seventy-five to seventy-nine years and then declined. The rates of complications occurring within ninety days after primary total Hip Replacement were 1.0% for mortality, 0.9% for pulmonary embolus, 0.2% for wound infection, 4.6% for hospital readmission, and 3.1% for Hip dislocation. The rates after revision total Hip Replacement were 2.6%, 0.8%, 0.95%, 10.0%, and 8.4%, respectively. Factors associated with an increased risk of an adverse outcome included increased age, gender (men were at higher risk than women), race (blacks were at higher risk than whites), a medical comorbidity, and a low income. Conclusions: Analysis of United States Medicare population data showed that the rates of total Hip Replacement increased with age up to the age of seventy-five to seventy-nine years and that blacks had a significantly lower rate of total Hip Replacement than whites. The overall rates of adverse outcomes were relatively low, but they were significantly higher after revision than after primary total Hip Replacement. Level of Evidence: Prognostic study, Level II-1 (retrospective study). See p. 2 for complete description of levels of evidence.

  • rates and outcomes of primary and revision total Hip Replacement in the united states medicare population
    Journal of Bone and Joint Surgery American Volume, 2003
    Co-Authors: Nizar N Mahomed, William H Harris, Jane Barrett, Jeffrey N Katz, Charlotte B Phillips, Elena Losina, Edward Guadagnoli, Robert Poss, John A Baron
    Abstract:

    Background: Information on the epidemiology of primary total Hip Replacement is limited, and we are not aware of any reports on the epidemiology of revision total Hip Replacement. The objective of this study was to characterize the rates and immediate postoperative outcomes of primary and revision total Hip Replacement in persons sixty-five years of age and older residing in the United States. Methods: We used Medicare claims submitted by hospitals, physicians, and outpatient facilities between July 1, 1995, and June 30, 1996, to identify individuals who had undergone elective primary total Hip Replacement for a reason other than a fracture (61,568 patients) or had had revision total Hip Replacement (13,483 patients). Annual incidence rates of primary and revision total Hip Replacement were calculated, and multivariate modeling was used to evaluate the association between patient characteristics and surgical rates. The rates of occurrence of five complications within ninety days postoperatively were also evaluated, and relationsHips between those outcomes and patient characteristics were assessed with use of multivariate models adjusted for hospital and surgeon volume. Results: The rates of primary total Hip Replacement were three to six times higher than the rates of revision total Hip Replacement. Women had higher rates than men, and whites had higher rates than blacks. The rates of primary and revision total Hip Replacement increased with age until the age of seventy-five to seventy-nine years and then declined. The rates of complications occurring within ninety days after primary total Hip Replacement were 1.0% for mortality, 0.9% for pulmonary embolus, 0.2% for wound infection, 4.6% for hospital readmission, and 3.1% for Hip dislocation. The rates after revision total Hip Replacement were 2.6%, 0.8%, 0.95%, 10.0%, and 8.4%, respectively. Factors associated with an increased risk of an adverse outcome included increased age, gender (men were at higher risk than women), race (blacks were at higher risk than whites), a medical comorbidity, and a low income. Conclusions: Analysis of United States Medicare population data showed that the rates of total Hip Replacement increased with age up to the age of seventy-five to seventy-nine years and that blacks had a significantly lower rate of total Hip Replacement than whites. The overall rates of adverse outcomes were relatively low, but they were significantly higher after revision than after primary total Hip Replacement. Level of Evidence: Prognostic study, Level II-1 (retrospective study). See p. 2 for complete description of levels of evidence.

  • incidence rates of dislocation pulmonary embolism and deep infection during the first six months after elective total Hip Replacement
    Journal of Bone and Joint Surgery American Volume, 2003
    Co-Authors: Charlotte B Phillips, William H Harris, Nizar N Mahomed, Jane Barrett, Elena Losina, Edward Guadagnoli, John A Baron, Elizabeth A Lingard
    Abstract:

    Background: The lengths of acute hospital stays following total Hip Replacement have diminished substantially in recent years. As a result, a greater proportion of complications occurs following discharge. Data on the incidence trends of major complications of total Hip Replacement would facilitate recognition and management of these adverse events. Methods: We used Medicare claims data on beneficiaries sixty-five years and older who had had elective, primary total Hip Replacement for a reason other than a fracture (58,521 patients) or had had revision total Hip Replacement (12,956 patients) between July 1, 1995, and June 30, 1996. We calculated incidence rates of dislocation, pulmonary embolism, and deep Hip infection per 10,000 person-weeks for four time-periods following the admission for the surgery (during the index hospitalization, from discharge to four weeks postoperatively, from five to thirteen weeks postoperatively, and from fourteen to twenty-six weeks postoperatively). We then used life-table methods to estimate the cumulative incidence of each complication over the first six postoperative months. Results: Of the patients who had had a primary total Hip Replacement, 3.9% had a dislocation, 0.9% had a pulmonary embolism, and 0.2% had a deep infection in the first twenty-six postoperative weeks. In the revision total Hip Replacement cohort, the proportions with dislocation, pulmonary embolism, and deep infection were 14.4%, 0.8%, and 1.1%, respectively. The rates of these adverse outcomes were highest during the index hospitalization, diminished considerably in the period from discharge to four weeks postoperatively, and continued to drop in the periods from five to thirteen and fourteen to twenty-six weeks postoperatively. Conclusions: The incidence rates of dislocation, pulmonary embolism, and deep infection are highest immediately after total Hip Replacement, but they continue to be elevated throughout the first three postoperative months. With the lengths of hospital stays continuing to diminish, an increasing proportion of complications will occur in outpatients. These findings provide a basis for developing strategies to prevent these complications in the postdischarge management of patients who have had elective total Hip Replacement. Level of Evidence: Prognostic study, Level II-1 (retrospective study). See p. 2 for complete description of levels of evidence.

  • association between hospital and surgeon procedure volume and outcomes of total Hip Replacement in the united states medicare population
    Journal of Bone and Joint Surgery American Volume, 2001
    Co-Authors: Jeffrey N Katz, William H Harris, Nizar N Mahomed, Jane Barrett, Charlotte B Phillips, Elena Losina, Robert A Lew, Edward Guadagnoli, Robert Poss, John A Baron
    Abstract:

    Background: The mortality and complication rates of many surgical procedures are inversely related to hospital procedure volume. The objective of this study was to determine whether the volumes of primary and revision total Hip Replacements performed at hospitals and by surgeons are associated with rates of mortality and complications. Methods: We analyzed claims data of Medicare recipients who underwent elective primary total Hip Replacement (58,521 procedures) or revision total Hip Replacement (12,956 procedures) between July 1995 and June 1996. We assessed the relationsHip between surgeon and hospital procedure volume and mortality, dislocation, deep infection, and pulmonary embolus in the first ninety days postoperatively. Analyses were adjusted for age, gender, arthritis diagnosis, comorbid conditions, and income. Analyses of hospital volume were adjusted for surgeon volume, and analyses of surgeon volume were adjusted for hospital volume. Results: Twelve percent of all primary total Hip Replacements and 49% of all revisions were performed in centers in which ten or fewer of these procedures were carried out in the Medicare population annually. In addition, 52% of the primary total Hip Replacements and 77% of the revisions were performed by surgeons who carried out ten or fewer of these procedures annually. Patients treated with primary total Hip Replacement in hospitals in which more than 100 of the procedures were performed per year had a lower risk of death than those treated with primary Replacement in hospitals in which ten or fewer procedures were performed per year (mortality rate, 0.7% compared with 1.3%; adjusted odds ratio, 0.58; 95% confidence interval, 0.38, 0.89). Patients treated with primary total Hip Replacement by surgeons who performed more than fifty of those procedures in Medicare beneficiaries per year had a lower risk of dislocation than those who were treated by surgeons who performed five or fewer of the procedures per year (dislocation rate, 1.5% compared with 4.2%; adjusted odds ratio, 0.49; 95% confidence interval, 0.34, 0.69). Patients who had revision total Hip Replacement done by surgeons who performed more than ten such procedures per year had a lower rate of mortality than patients who were treated by surgeons who performed three or fewer of the procedures per year (mortality rate, 1.5% compared with 3.1%; adjusted odds ratio, 0.65; 95% confidence interval, 0.44, 0.96). Conclusions: Patients treated at hospitals and by surgeons with higher annual caseloads of primary and revision total Hip Replacement had lower rates of mortality and of selected complications. These analyses of Medicare claims are limited by a lack of key clinical information such as operative details and preoperative functional status.