Special study shows post-surgical complications most likely causes of hospitalization
March 26, 2008 — One out of every seven patients who undergoes a knee or elective hip replacement procedure returns to the hospital within one year, in some cases because of complications related to their surgery. Today, the Canadian Institute for Health Information (CIHI) releases two publications, the annual Canadian Joint Replacement Registry report and a special study, Hospitalizations, Early Revisions and Infections Following Joint Replacements. According to the special study, 51,029 people underwent a first-time knee or elective hip replacement (outside of Quebec) in 2005–2006. Of these patients, more than 7,700 were hospitalized at least once in the subsequent 12 months. Compared to hospital use by the same group of patients in the year before surgery, this represents an increase of more than 2,000 patients hospitalized and an extra 44,000 hospital days.
“While joint replacement surgery can certainly improve the quality of a patient’s life, it is not always without complications,” says Tracy Johnson, Project Consultant at CIHI. “Investigating the reasons for these extra hospitalizations can offer opportunities to improve quality, reduce costs and improve both hospital and surgeon availability for other patients who need care.”
Infections and early revisions among the most serious post-surgery hospitalizations
The most common reason people are admitted to hospital after undergoing either an elective (non-emergency) hip replacement or a knee replacement is complications directly associated with the surgery, such as loosening of the prosthesis, dislocation or infection. These accounted for 18% of the hospitalizations in the year following joint replacement surgery.
Patients hospitalized for infection spent on average twice as long in hospital when compared with those admitted for other reasons following surgery. Men were more likely than women to have a post-surgical hospitalization for infection, and patients with diabetes had a higher rate of infection than those without. Just more than 1% of patients were hospitalized for a revision surgery (meaning the new joint is removed and replaced) within one year. Elective hip patients were more likely to require this second surgery than knee replacement patients.
Both hip and knee replacement patients were more likely to be hospitalized in the year following their surgery than in the year before, though the change was greater for knee replacement patients. While hospital admissions for those who underwent knee replacements increased by 52% in the year following their surgery, they increased by only 15% for elective hip replacement patients.
Additional hospital stays estimated to cost $45 million
When the study looked at both knee and elective hip replacement patients, it found this group spent 44,000 more days in hospital in the year after surgery than in the year before. The increase was due to the overall rise in hospitalizations and because these patients tend to stay longer in the hospital. The costs associated with additional hospitalizations in the year after elective joint replacement surgery are estimated to be $45 million in Canada (outside Quebec).
Additional highlights from Hip and Knee Replacements in Canada
- In 2004, Canada’s first ministers identified joint replacement as a priority for wait time reduction. In 2005–2006, the first fiscal year following the agreement, hip and knee replacements grew by 17% when adjusted for age and other demographic changes in the population.
- In 2005–2006 there were 68,746 hospitalizations for hip (28,045) and knee (40,701) replacements performed in Canada (including primary and revision procedures), representing a 10-year increase in the number of procedures performed of 100%.
- The majority (63%) of Canadians receiving a joint replacement in 2005–2006 were 65 years of age or older.
- The rates of hip and knee replacements among 45 to 54 year olds have risen considerably in the last decade. The rate of knee replacements has tripled for males and more than tripled for females, while the rate of hip replacements has increased by 68% for men and 52% for women over the same time period.
- The most notable increase was seen in knee replacements for women aged 55 to 64; in 2005–2006, there were 6,217 knee replacements performed on females in this age group, which was a 229% increase from the 1,892 performed 10 years before, in 1995–1996.
The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI’s goal: to provide timely, accurate and comparable information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health. www.cihi.ca.