A learning curve of total knee arthroplasty (TKA) based on surgical volume analysis

Abstract

The purpose of this study is to discover valuable medical facts by utilizing the Taiwan National Health Insurance (NHI) database, which contains 32,200 records of TKA surgeries. Three main objectives of this paper include the following: (a) building learning curves of TKA from the target database; (b) characterizing how the TKA volume correlates with infection rate and mortality; (c) examining the differences of infection rate and mortality between the medical center (Group I) and the non-medical center (Group II). The TKA samples are classified into two groups according to their institution type (medical center and non-medical center). The Z-test is used to test whether there are differences in the infection rate and mortality between the two observed groups. This study also adopts linear/nonlinear regression to investigate the relationship between TKA volume and the infection rate (mortality). This study has three main findings: (a) it confirms a correlation between the TKA surgical volumes and certain outcomes, (b) surgeons and hospitals with higher TKA volumes exhibit better operation quality, lower postoperative complication rate, and (c) there are significant differences in infection and mortality rate between Group I and Group II.