Association between surgical volume and failure of primary total hip replacement in England and Wales: findings from a prospective national joint replacement register

Sayers, Adrian; Steele, Fiona; Whitehouse, Michael R; Price, Andrew; Ben‐Shlomo, Yoav; Blom, Ashley W

doi:10.1136/bmjopen-2019-033045

Cited by 13 publications

(10 citation statements)

References 26 publications

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“…The authors reported an inflection point of 70 TKA per year with surgeons performing fewer cases having a relative risk for all-cause revisions increasing by 31% and the relative risk of PJI increasing by 18%. 28 Using data from the National Joint Registry of England, Wales, Northern Ireland, and Isle of Man, Sayers et al 29 evaluated 579,858 primary THA patients and found a near-linear 43% (95% CI, 29.1%-57.4%) reduction of all-cause revision, compared with surgeons with lower annual volume (<200 procedures). Furthermore, Jeschke et al 19 reported patients having TKA at a high-volume hospital to be associated with a decreased risk of having revision TKA within 2 years of the index surgery, even after controlling for clinical factors and socioeconomic variables.…”

Section: Discussionmentioning

confidence: 99%

Effects of Hospital and Surgeon Volume on Patient Outcomes After Total Joint Arthroplasty: Reported From the American Joint Replacement Registry

Alamanda

Barrington

Chen

et al. 2022

J Am Acad Orthop Surg

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Background: The purpose of this study was to evaluate outcomes and complications because it relates to surgeon and hospital volume for patients undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) using the American Joint Replacement Registry from 2012 to 2017.Methods: A retrospective study was conducted on Medicare-eligible cases of primary elective THAs and TKAs reported to the American Joint Replacement Registry database and was linked with the available Centers of Medicaid and Medicare Services claims and the National Death Index data from 2012 to 2017. Surgeon and hospital volume were defined separately based on the median annual number of anatomic-specific total arthroplasty procedures performed on patients of any age per surgeon and per hospital. Values were aggregated into separate surgeon and hospital volume tertile groupings and combined to create pairwise comparison surgeon/hospital volume groupings for hip and knee.Results: Adjusted multivariable logistic regression analysis found low surgeon/low hospital volume to have the greatest association with allcause revisions after THA (odds ratio [OR], 1.63, 95% confidence interval [CI], 1.41-1.89, P , 0.0001) and TKA (OR, 1.72, 95% CI, 1.44-2.06, P , 0.0001), early revisions because of periprosthetic joint infection after THA (

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Section: Discussionmentioning

confidence: 99%

Effects of Hospital and Surgeon Volume on Patient Outcomes After Total Joint Arthroplasty: Reported From the American Joint Replacement Registry

Alamanda

Barrington

Chen

et al. 2022

J Am Acad Orthop Surg

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“…Group mean centring and multilevel models have been used successfully to investigate different aspects of surgical volume, and offer novel insights into the effect of surgeon volume on revision risk after hip replacement 38. One study found that about 200 mean annual hip replacements were required to attain a plateau for revision risk, and indeed, different surgical procedures seem to have noticeably different volume-outcome associations 39.…”

Section: Discussionmentioning

confidence: 99%

Association between surgeon volume and patient outcomes after elective shoulder replacement surgery using data from the National Joint Registry and Hospital Episode Statistics for England: population based cohort study

Valsamis

Collins

Pinedo-Villanueva

et al. 2023

BMJ

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ObjectiveTo investigate the association between surgeon volume and patient outcomes after elective shoulder replacement surgery to improve patient outcomes and inform future resource planning for joint replacement surgery.DesignProspective cohort study.SettingPublic and private hospitals in the United Kingdom, 2012-20.ParticipantsAdults aged 18 years or older who had shoulder replacement surgery, identified in the National Joint Registry, with linkage of participants in England to Hospital Episode Statistics data.Main outcome measuresThe main outcome measure was revision surgery. Secondary outcome measures were reoperation within 12 months, serious adverse events, and prolonged hospital stay (>3 nights) after shoulder replacement surgery.Results39 281 shoulder replacement procedures undertaken by 638 consultant surgeons at 416 surgical units met the inclusion criteria and were available for analysis. Multilevel mixed effects models and restricted cubic splines were fit to examine the association between a surgeon’s mean annual volume and risk of adverse patient outcomes, with a minimum volume threshold of 10.4 procedures yearly identified. Below this threshold the risk of revision surgery was significantly increased, as much as twice that of surgeons with the lowest risk (hazard ratio 1.94, 95% confidence interval 1.27 to 2.97). A greater mean annual surgical volume was also associated with a significantly lower risk of reoperations, fewer serious adverse events, and shorter hospital stay, with no thresholds identified. Annual variation in surgeon volume was not associated with any of the outcomes assessed.ConclusionsIn the healthcare system represented by these registry data, an association was found between surgeons who averaged more than 10.4 shoulder replacements yearly and lower rates of revision surgery and reoperation, lower risk of serious adverse events, and shorter hospital stays. These findings should inform resource planning for surgical services and joint replacement surgery waiting lists and improve patient outcomes after shoulder replacement surgery.

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“…As well as improving the decision-making process in revision, one of the effects of EMSON has been to reduce revision surgery performed by low-volume surgeons and concentrating such surgery within experienced teams. There is evidence of a volume-outcome relationship for THA and TKA, 33-37 along with growing evidence for improved outcomes in rTKA with higher volumes. Roof et al 38 showed improved outcomes within the same unit for higher-volume surgeons performing more than 19 rTKA procedures per year.…”

Section: Discussionmentioning

confidence: 99%

The impact of a revision arthroplasty network on patient outcomes

et al. 2023

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AimsRevision total knee arthroplasty (rTKA) and revision total hip arthroplasty (rTHA) are complex procedures with higher rates of re-revision, complications, and mortality compared to primary TKA and THA. We report the effects of the establishment of a revision arthroplasty network (the East Midlands Specialist Orthopaedic Network; EMSON) on outcomes of rTKA and rTHA.MethodsThe revision arthroplasty network was established in January 2015 and covered five hospitals in the Nottinghamshire and Lincolnshire areas of the East Midlands of England. This comprises a collaborative weekly multidisciplinary meeting where upcoming rTKA and rTHA procedures are discussed, and a plan agreed. Using the Hospital Episode Statistics database, revision procedures carried out between April 2011 and March 2018 (allowing two-year follow-up) from the five network hospitals were compared to all other hospitals in England. Age, sex, and mean Hospital Frailty Risk scores were used as covariates. The primary outcome was re-revision surgery within one year of the index revision. Secondary outcomes were re-revision surgery within two years, any complication within one and two years, and median length of hospital stay.ResultsA total of 57,621 rTHA and 33,828 rTKA procedures were performed across England, of which 1,485 (2.6%) and 1,028 (3.0%), respectively, were conducted within the network. Re-revision rates within one year for rTHA were 7.3% and 6.0%, and for rTKA were 11.6% and 7.4% pre- and postintervention, respectively, within the network. This compares to a pre-to-post change from 7.4% to 6.8% for rTHA and from 11.7% to 9.7% for rTKA for the rest of England. In comparative interrupted time-series analysis for rTKA there was a significant immediate improvement in one-year re-revision rates for the revision network compared to the rest of England (p = 0.024), but no significant change for rTHA (p = 0.504). For the secondary outcomes studied, there was a significant improvement in trend for one- and two-year complication rates for rTHA for the revision network compared to the rest of England.ConclusionRe-revision rates for rTKA and complication rates for rTHA improved significantly at one and two years with the introduction of a revision arthroplasty network, when compared to the rest of England. Most of the outcomes studied improved to a greater extent in the network hospitals compared to the rest of England when comparing the pre- and postintervention periods.Cite this article: Bone Joint J 2023;105-B(6):641–648.

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Association between surgical volume and failure of primary total hip replacement in England and Wales: findings from a prospective national joint replacement register

Cited by 13 publications

References 26 publications

Effects of Hospital and Surgeon Volume on Patient Outcomes After Total Joint Arthroplasty: Reported From the American Joint Replacement Registry

Effects of Hospital and Surgeon Volume on Patient Outcomes After Total Joint Arthroplasty: Reported From the American Joint Replacement Registry

Association between surgeon volume and patient outcomes after elective shoulder replacement surgery using data from the National Joint Registry and Hospital Episode Statistics for England: population based cohort study

The impact of a revision arthroplasty network on patient outcomes

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