Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments (1)

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*

You may also like these posts

    None Found

Read comments »

One Response to “Regional Variations in Total Knee Replacement Surgery”

  1. Robert says:

    Looks like the south is doing a poor job in keeping costs low, at least as it relates to knee replacements.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »