Effect of hospital volume on outcomes of total hip arthroplasty: A systematic review and meta-analysis

Syed Hamza Mufarrih, Muhammad Owais Abdul Ghani, Russell Seth Martins, Nada Qaisar Qureshi, Sayyeda Aleena Mufarrih, Azeem Tariq Malik, Shahryar Noordin

Research output: Contribution to journalReview articlepeer-review

45 Citations (Scopus)


Background: A shift in the healthcare system towards the centralization of common yet costly surgeries, such as total hip arthroplasty (THA), to high-volume centers of excellence, is an attempt to control the economic burden while simultaneously enhancing patient outcomes. The "volume-outcome" relationship suggests that hospitals performing more treatment of a given type exhibit better outcomes than hospitals performing fewer. This theory has surfaced as an important factor in determining patient outcomes following THA. We performed a systematic review with meta-analyses to review the available evidence on the impact of hospital volume on outcomes of THA. Materials and methods: We conducted a review of PubMed (MEDLINE), OVID MEDLINE, Google Scholar, and Cochrane library of studies reporting the impact of hospital volume on THA. The studies were evaluated as per the inclusion and exclusion criteria. A total of 44 studies were included in the review. We accessed pooled data using random-effect meta-analysis. Results: Results of the meta-analyses show that low-volume hospitals were associated with a higher rate of surgical site infections (1.25 [1.01, 1.55]), longer length of stay (RR, 0.83[0.48-1.18]), increased cost of surgery (3.44, [2.57, 4.30]), 90-day complications (RR, 1.80[1.50-2.17]) and 30-day (RR, 2.33[1.27-4.28]), 90-day (RR, 1.26[1.05-1.51]), and 1-year mortality rates (RR, 2.26[1.32-3.88]) when compared to high-volume hospitals following THA. Except for two prospective studies, all were retrospective observational studies. Conclusions: These findings demonstrate superior outcomes following THA in high-volume hospitals. Together with the reduced cost of the surgical procedure, fewer complications may contribute to saving considerable opportunity costs annually. However, a need to define objective volume-thresholds with stronger evidence would be required.

Original languageEnglish
Article number468
JournalJournal of Orthopaedic Surgery and Research
Issue number1
Publication statusPublished - 27 Dec 2019


  • Hospital volume
  • Low-volume hospitals vs. high-volume hospitals
  • THA
  • THA outcomes
  • Total hip arthroplasty
  • Total hip replacement


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