Little is known about the factors that drive hospital-switching behavior of patients when they seek a second total joint arthroplasty (TJA) surgery.
We analyzed the population-based, all-payer California Healthcare Cost and Utilization Project (HCUP) data for a cohort undergoing sequential TJAs for osteoarthritis (N = 48,800) from 2006 to 2011, excluding TJA for fracture. We used multivariable logistic regression analysis to identify factors associated with returning to the same hospital for each surgery, including rural or urban, surgery sequence and timing, Deyo-Charlson comorbidity index, age, sex, race and ethnicity, and insurance.
Overall, 15.1% of subjects (7,364/48,000) utilized a different hospital for their second surgery. Increasing years between TJAs was associated with decreasing odds of going to the same hospital for the second TJA (p < 0.05). Subjects switching from private insurance to Medicare between surgeries were much less likely to return to same hospital (OR: 0.53; 95% CI: 0.47-0.59), as were those with alternate-joint sequencing (e.g., hip-knee). Those with Medicaid were somewhat less likely to return for the second surgery (OR: 0.87; 95% CI: 0.75-1.01). Urban and rural residents were equally likely to return to the same hospital (p > 0.05). Increasing age was associated with increasing likelihood of returning to the same hospital [e.g., ages 75- 79, OR: 1.36 (95% CI: 1.19-1.56) and ages 80+, OR: 1.41 (95% CI: 1.22-1.63)].
Fifteen percent of patients switched hospitals for their second TJA within the 6-year study period. Those with Medicare or who had surgery on the alternate joint for second surgery were more likely to switch hospitals as were those who waited longer between surgeries and those living in a rural environment.