Regional Variations in Total Knee Replacement Surgery
It has been proven than there is tremendous variation in the practice of medicine across the United States. The Dartmouth data (Wennberg et al) has documented the differences in how medical resources are used and how different physicians practice medicine, depending upon where they live. The Dartmouth studies are mainly focused on cost and outcomes and make the case that improved quality is often inversely related to the cost of care. More (expensive) care is not necessarily better care.
Now that I am recovering from a total joint replacement, I am amazed to see the differences in how physicians, doing the same surgery, treat the patient. Total knee replacement (TKA) is one of the most common orthopedic procedures done today. Despite this, the patient cannot expect the same post op care.
I am in contact with a patient in rural Minnesota who had the same surgery 8 days prior to me. Here are some differences in treatment for the same surgery (TKA):
San Francisco - Hospital Stay was 4 days. Anticoagulants were used to prevent blood clots.
Minnesota - Hospital Stay was 10 days. Anticoagulants were not used and patient suffered deep vein thrombosis and pulmonary embolus requiring 3 days in ICU and several months of blood thinners afterward.
San Francisco-Patient sent home with narcotic pain relief and encouraged to take them for comfort and good sleep.
Minnesota- Patient sent home with only enough pain pills to use at night and to stretch them out.
San Francisco-Patient given home visiting physical therapy
Minnesota- Patient given exercises to to on her own without PT.
San Francisco-Wound closed with steri-strips
Minnesota-Wound closed with staples that are present 3 weeks post op and driving patient crazy
Except for the Pulmonary embolus (potentially a fatal event!) and the increase hospital cost, these are all differences that probably do not affect the total outcome one year post op. But with such a common surgery, I can’t help but wonder why these variations in care occur? The surgeon’s own preferences seem to determine what happens to the patient and how much pain and disability go along with the surgery.
I am glad I am receiving my care in San Francisco.
*This blog post was originally published at EverythingHealth*
Looks like the south is doing a poor job in keeping costs low, at least as it relates to knee replacements.