How safe is primary knee replacement surgery? Perioperative complication rates in northern Illinois, 1993-1999

Objective. To describe inpatient complications for primary total knee replacement (TKR) in a period of rapidly growing orthopedic surgery capacity, declining length of stay, and more frequent discharge to rehabilitation facilities. Methods. Complication incidence according to published coding algorithms was estimated for 35,531 primary TKR admissions of northern Illinois residents to 65 Illinois hospitals. Complication odds were estimated as a function of patients' clinical and sociodemographic status, hospital volume, residency training, TKR length of stay, International Classification of Diseases, Ninth Revision (ICD-9) coding intensity, and discharges to skilled nursing or rehabilitation facilities. Results. Primary TKR admissions increased 36% between 1993 and 1999, length of stay declined 43%, average ICD-9 code use increased 31%, and rehabilitation discharges increased 68%. Major complication rates declined 44% (12.4% to 6.9%; P < 0.0001) over this period, reflecting a 50% reduction in the adjusted odds of complication between 1993 and 1999. There was no association of procedure volume and outcome. Conclusion. It is likely that the reduction in complications reflects true safety improvements as well as reduced length of stay.