Comparison of US and Canadian Perioperative Outcomes and Hospital Efficiency After Total Hip and Knee Arthroplasty
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
IMPORTANCE: The combination of an aging population, growing number of medical interventions, and surging economic burden of health care has renewed interest in reevaluating and exploring new health care models. OBJECTIVES: To compare the performance of the US and Canadian health care systems by assessing major complications following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) and to measure the efficiency of both health care models by comparing the postoperative length of stay. DESIGN, SETTING, AND PARTICIPANTS: With patients grouped according to the country where they underwent surgery, we queried the National Surgical Quality Improvement Program database to identify 55,335 Canadian and US patients who underwent primary elective THA or TKA between January 1, 2011, and December 31, 2012. MAIN OUTCOMES AND MEASURES: Differences in patient demographics, as well as the rate of 30-day major complications and length of stay, were compared between patients hospitalized in the United States and Canada. RESULTS: Baseline characteristics were similar between the groups. Most US patients underwent general anesthesia (THA, 61.8%; TKA, 59.4%); Canadian patients received more regional anesthesia (THA, 78.7%; TKA, 81.0%). Patients in the United States received more transfusions postoperatively (THA, 9.0% more; TKA, 6.4% more; P < .001) and had shorter hospitalizations (THA, 1.4 days less; TKA, 1.3 days less; P < .001) with a greater proportion of patients discharged to rehabilitation facilities (THA, 21.6% more; TKA, 26.6% more; P < .001). With results reported as incidence rate ratios (95% CIs), after adjusting for all other variables, risk factors, and adverse outcomes, having surgery in Canada increased the postoperative length of stay by 57% (1.57 [1.53-1.61]) for THA and 49% (1.49 [1.46-1.52]) for TKA. With results reported as odds ratios (95% CIs), major complications were significantly more common in Canada following TKA (1.65 [1.31-2.07]) but not THA (1.09 [0.79-1.51]). CONCLUSIONS AND RELEVANCE: The rate of major complications was significantly higher in Canada following TKA, but there was no significant difference following THA. Patients undergoing the procedures in US hospitals also had substantially shorter lengths of hospital stay, perhaps reflecting more efficient postoperative care and discharge planning in those facilities.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it