AN ANALYSIS OF PRACTICE VARIATIONS CONCERNING THE ARTHROPLASTY OF HIP IN OLD PATIENTS, USING ADMINISTRATIVE AND CLINICAL DATA FROM HOSPITALS
Abstract:
Background: The evaluation of practice variations is necessary for hospital performance improvement, cost containment and better care, in Romania, as well as in other countries. Methods: This is an observational descriptive retrospective study; patient level clinical data for 60 years old and over patients from nationwide acute care and per cases financed hospitals were used; the following were analyzed: socio-demographic features, volume of hospital services, average length of stay, diagnoses for patients with a principal surgical procedure having the block code 1489, arthroplasty of hip. Results: Arthroplasty of hip for inpatients, 60 years old and over represents 70% of all arthroplasty procedures for all age groups. The percentage of arthroplasty of hip from the total number of principal surgical procedures varies in 2008 with the district of the hospital between 0, 08% and 4,95%, and the average length of stay between 11, 1 and 29 days. Arthroplasty of hip was almost two times more frequent in women than in men. Only 12 districts reported more than 100 cases in this period. Conclusions: Romania has a lower rate of arthroplasty of hip, in comparison with international data and a higher length of stay. Practice variations are widespread on national territory; possible explanations could be the higher availability of resources in large hospitals, or the appropriate expertise in surgeons from these hospitals. Further analysis should focus on performance (complications, mortality rates) in hospitals from districts with 100 or less such procedures yearly.
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