The number of surgeries performed at a hospital is easily measured and has been used as a marker for clinical expertise. Procedure volume (number of cases per hospital or surgeon) has therefore become a widely-used quality indicator for surgery. However, some hospitals may have fewer procedures performed per year and still have excellent outcomes.
A study of 80,904 Medicare patients demonstrated that patients receiving primary (first time) total knee replacement in higher-volume hospitals (hospitals with an annual volume exceeding 200 primary and revision total knee replacement procedures) generally have lower rates of mortality, pneumonia, and deep knee infection than do patients managed in lower-volume hospitals (hospitals with an annual volume of 25 primary and revision total knee replacement procedures or fewer) (The Journal of Bone and Joint Surgery, 2004: 86; 1909-1916).
Other important factors associated with higher complication rates following total knee replacement are advanced patient age and additional patient health problems (The Journal of Bone and Joint Surgery, 2006; 88: 480-485). Those who are elderly, or who have multiple health problems may benefit the most from having knee replacement surgery at a facility with a higher volume of surgeries performed.