Knee osteoarthritis is a common ailment—and treatment is expensive: in 2008 total knee replacement inpatient costs in the United States exceeded $9 billion—the highest among the ten procedures for which demand is growing the fastest. A new study, released today as a Web First by Health Affairs, compares operating times, hospital lengths-of-stay, discharge dispositions, and in-hospital complication rates for knee replacements at five organizations, all members of the High Value Healthcare Collaborative.

Ivan Tomek of the Dartmouth-Hitchcock Medical Center and coauthors identify three key findings:

  • The health system with the lowest in-hospital complication rate brought together patients with a multispecialty team prior to the surgery, including members from anesthesiology and internal medicine to co-manage medically complex patients.
  • The fastest operating times (and shortest patient stays) were at a hospital where knee replacement cases were staffed by a team of anesthesia doctors, scrub techs, and nurses specializing in arthroplasty.
  • The health system that involved patients prior to surgery in their discharge planning process (and managed patient expectations about disposition after hospitalization) had shorter hospitalizations.

The goal of the study was to identify opportunities to improve health care value by increasing the quality and reducing the cost of this procedure. The data consisted of 10,910 single knee replacement surgeries in 2008 and 2009 from the five health care delivery systems (Cleveland Clinic, Denver Health, Dartmouth Institute for Health Policy and Clinical Practice, Intermountain Healthcare, and Mayo Clinic). Additionally, authors found that longer hospital stays were the result of surgeries done later in the week and to older and sicker patients.

Based on these results, the Collaborative recommends more coordinated management for medically complex patients, more use of specialized staff, and a process to improve the management of patient expectations. These innovations are being tried by the Collaborative’s members to evaluate whether they increase health care value.