PHC4 | Orthopedic Surgery in Pennsylvania, 2010

Orthopedic Surgery in Pennsylvania, 2010 - News Release

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PHC4 REPORT SHOWS JOINT REPLACEMENT SURGERY INCREASING IN PA

Harrisburg, PA - April 4, 2012 - The number of Pennsylvania residents undergoing total joint replacement of knees, hips and shoulders increased significantly between 2006 and 2010, according to a new report released today by the Pennsylvania Health Care Cost Containment Council (PHC4.) During the five-year period covered in Orthopedic Surgery in Pennsylvania, 2010, hospitalizations rose 16.1 percent for total knee replacement, 22.2 percent for total hip replacement, and 100 percent for total shoulder replacement.

In 2010, about one in every 200 Pennsylvanians age 18 and over (48,572) had knee, hip or shoulder replacement surgery. The rate for those age 65 and over was one in 75. Overall, 52,225 patients, PA and non-PA residents, underwent these types of total joint replacement in Pennsylvania hospitals.

The report also found that one in every 350 state residents age 18 and over (28,090) underwent a common spine procedure in 2010. The rate was higher, at one in every 220, among patients age 65 and over. Overall, 31,005 patients, PA and non-PA residents, underwent common spine procedures in Pennsylvania hospitals. Although hospitalizations for spinal fusion increased by 31.6 percent between 2006 and 2010, the rate dropped by 29.9 percent for discectomy and by 8.6 percent for decompression laminectomy.

“Joint replacement and spinal fusion surgeries have increased significantly in the United States over the past several years, and Pennsylvania has followed the national trend,” said Joe Martin, executive director of PHC4. “At the same time, within our state, we see marked disparities based on geography, gender and race in the number of people undergoing orthopedic procedures.”

The report pointed to differences in the rate of orthopedic-related hospitalizations in various parts of Pennsylvania. In 2010, for five of the six major procedures on which the report focused -- hip and knee replacement, spinal fusion, discectomy, and decompression laminectomy -- western Pennsylvania counties had higher rates than the rest of the state. Central/Northeastern Pennsylvania counties had the top rate of shoulder replacements. If inpatient and outpatient settings are combined, then Central/Northeastern counties had the highest rate of decompression laminectomy. (The regional data is adjusted for age and gender difference.)

For all six types of procedures, white non-Hispanics had higher hospitalization rates than both black non-Hispanics and Hispanics in 2009 (the last year for which US Census Bureau data on ethnicity was available for this report). Pennsylvania females had higher hospitalization rates than males for all three types of total joint replacement surgeries, and for spinal fusion in 2010. Men had a higher rate than women for both discectomy and decompression laminectomy.

Among the other key findings in the report:

For the procedures examined in the orthopedic surgery report, the highest rate of hospital readmission within 30 days for a complication or infection was among patients who underwent a decompression laminectomy – about 1 in 18 patients, or 5.6 percent.
The highest rate of healthcare-associated infections was among those who underwent spinal fusion – about 1 in 36, or 2.8 percent.
In 2009, the most recent year for which Medicare payment data is available, Medicare fee-for-service (FFS) payments totaled more than $193 million for Pennsylvanians who were hospitalized for total joint replacement and approximately $100 million for those who were hospitalized for a common spine procedure. The highest average Medicare FFS payment was for spinal fusion, at $23,258 per patient.
In 2009, the most recent year for which Medicaid payment data is available, Medicaid FFS payments totaled approximately $4.8 million for Pennsylvanians who were hospitalized for total joint replacement and more than $10.5 million for those who were hospitalized for a common spine procedure. The highest average Medicaid FFS payment was for spinal fusion, at $15,283 per patient.

PHC4 is an independent state agency charged with collecting, analyzing and reporting information that can be used to improve the quality and restrain the cost of health care in Pennsylvania. Copies of the free report can be downloaded from PHC4’s website at http://www.phc4.org.