Question:My husband had bone cancer several years ago, which seems to be under control. Now he needs a knee replacement. His oncologist wants him to go to a specialty orthopedic hospital for the surgery. Is this really necessary?
Answer:Some medical conditions put patients at a higher risk for complications after surgery. A previous history of cancer affecting the bone or previous joint replacement surgery are two common examples.
Older adults with serious bone fractures may also be advised to seek the services of a surgeon in a specialty clinic. Complicating factors such as osteoporosis or poor nutrition may be present. Or infection or diabetes may require extra care.
In a specialty clinic or hospital, the staff is trained to work with at-risk or high-risk patients. They have steps already worked out to deal with typical emergencies that might come up. And if they cannot handle the problem, they know when to transfer the patient to a more acute care setting.
Specialty clinics are fairly new. Studies to compare them to general hospitals are just beginning to get published. Based on large groups of Medicare patients, it looks like specialty hospitals do perform better than general hospitals. This is especially true for specific patient groups.
The risk of adverse outcomes including death are 50 per cent lower in specialty orthopedic hospitals. Specialty hospitals may deliver better care but there may be other interpretations of those outcomes. More study is needed to sort this all out.Peter Cramm, MD, MBA, et al. A Comparison of Total Hip and Knee Replacement in Specialty and General Hospitals. In The Journal of Bone and Joint Surgery. August 2007. Vol. 89-A. No. 8. Pp. 1675-1684.
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