Is There an Influence of Surgeon’s Experience on the Clinical Course in Patients With a Proximal Femoral Fracture?

Canal, Claudio; Kaserer, Alexander; Ciritsis, Bernhard; Simmen, Hans‐Peter; Neuhaus, Valentin; Pape, Hans-Christian

doi:10.1016/j.jsurg.2018.04.010

Cited by 8 publications

(13 citation statements)

References 41 publications

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“…In general, teaching is a risk factor for a worse outcome. The significantly higher frequency of teaching operations at HVCs was associated with prolonged LOS, which is consistent with observations for teaching procedures in relation to hip fractures [ 12 , 44 ] and general surgeries [ 45 ]. Otherwise, a large databank study of emergency and general surgeries found no difference in LOS between teaching and nonteaching surgeries [ 46 ] .…”

Section: Discussionsupporting

confidence: 85%

“…The AQC data contain information on patient age and gender, specifications about the type of admission (registered/planned or emergency), insurance status (private or statutory), length of hospital stay, time in the intensive care unit (ICU), concomitant injuries, American Society of Anesthesiologists (ASA) score (physical status classification system), comorbidities, need for reintubation and information about the discharge status (death, home, nursing home, senior residence, rehabilitation clinic and others). Moreover, the following procedural characteristics were available: fracture site (classified according to ICD-10 [ 18 ]); education level of the surgeon (divided into three groups—senior attending, junior attending (fellow) and residents); teaching status of the operation; procedure code (coded according to the CHOP code [ 19 ]) and duration of the surgery; other interventions; presence and severity of any perioperative complications (no complications, complications with conservative therapy, complications with surgical therapy, complications with long-term damage with conservative therapy and mortality); and the use of thromboembolism prophylaxis and antibiotics [ 12 ].…”

Section: Methodsmentioning

confidence: 99%

“…In this context, there is a lack of valid data to compare the outcome of malleolar fractures between high-volume centres (HVCs) and low-volume centres (LVCs). Apart from the aspect of centralisation, teaching has an important influence on outcome [ 12 ]. Treating ankle fractures is a standard teaching procedure for surgical residents due to the high incidence and standardised treatment.…”

Section: Introductionmentioning

confidence: 99%

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Short-term outcome of isolated lateral malleolar fracture treatment is independent of hospital trauma volume or teaching status: a nationwide retrospective cohort study

Vehling

Canal

Ziegenhain

et al. 2021

Eur J Trauma Emerg Surg

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Introduction In light of current discussions about centralisation and teaching in medicine, we wanted to investigate the differences in in-hospital outcomes after surgical treatment of isolated ankle fractures, taking into account high-volume centres (HVCs) and low-volume centres (LVCs) and teaching procedures. Methods A retrospective analysis of malleolar fractures recorded in a National Quality Assurance Database (AQC) from the period 01-01-1998 to 31-12-2018 was carried out. Inclusion criteria were isolated, and operatively treated lateral malleolar fractures (ICD-10 Code S82.6 and corresponding procedure codes). Variables were sought in bivariate and multivariate analyses. A total of 6760 cases were included. By dividing the total cases arbitrarily in half, 12 HVCs (n = 3327, 49%) and 56 LVCs (n = 3433, 51%) were identified. Results Patients in HVCs were younger (48 vs. 50 years old), had more comorbidities (26% vs. 19%) and had more open fractures (0.48% vs. 0.15%). Open reduction and internal fixation was the most common operative treatment at HVCs and LVCs (95% vs. 98%). A more frequent use of external fixation (2.5% vs. 0.55%) was reported at HVCs. There was no difference in mortality between treatment at HVCs and LVCs. A longer hospitalisation of 7.2 ± 5 days at HVCs vs. 6.3 ± 4.8 days at LVCs was observed. In addition, a higher rate of complications of 3.2% was found at HVCs compared to 1.9% at LVCs. The frequency of teaching operations was significantly higher at HVCs (30% vs. 26%). Teaching status had no influence on mortality or complications but was associated with a prolonged length of stay and operating time. Conclusion We found significant differences between HVCs and LVCs in terms of in-hospital outcomes for ankle fractures. These differences could be explained due to a more severely ill patient population and more complex (also open) fracture patterns with resulting use of external fixation and longer duration of surgery. However, structural and organisational differences, such as an extended preoperative stays at HVCs and a higher teaching rate, were also apparent. No difference in mortality could be detected.

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Section: Discussionsupporting

confidence: 85%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Short-term outcome of isolated lateral malleolar fracture treatment is independent of hospital trauma volume or teaching status: a nationwide retrospective cohort study

Vehling

Canal

Ziegenhain

et al. 2021

Eur J Trauma Emerg Surg

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“…Total hip arthroplasty (THA) is one of the most common surgical procedures taught in every medical residency program in orthopaedics, with hip surgeons (HSs) taking on teaching leading role [ 1 ]. It remains challenging for HSs to provide excellence in surgical treatment while training orthopaedic residents (ORs) in the arthroplasty technique [ 2 , 3 ]. In this sense, there is a lack of information regarding comparative radiographic results in patients operated by HSs or ORs.…”

Section: Introductionmentioning

confidence: 99%

Who Restores Hip Biomechanics More Effectively after a Femoral Neck Fracture? Comparison of Total Hip Arthroplasties Performed by Either Hip Surgeons or Orthopaedic Residents

et al. 2020

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Background This study aims to analyze the ability to restore hip biomechanics in patients who undergo total hip arthroplasty for displaced femoral neck fractures operated by either hip surgeons (HSs) or orthopaedic residents (ORs). Methods We retrospectively compared 95 patients treated by HSs (group A) with 110 patients treated by ORs (group B). Leg-length discrepancy, femoral offset (FO), center of rotation (COR), acetabular inclination, and acetabular anteversion were evaluated on postoperative radiographs using the healthy contralateral hip as control. Results The median leg-length discrepancy was 2 mm for both groups ( P = .74). The leg length was increased in 54% of the HS group and 57% of the OR group ( P = .13). The median FO difference of groups A and B were 7 mm and 5.5 mm, respectively ( P = .14). FO was increased in 80% of the HS group and 69% of the OR group ( P = .19). Median discrepancies of the horizontal and vertical CORs were not statistically relevant, with P -values of .69 and .14, respectively. The horizontal COR was slightly medialized in 58% of the HS group and 53% of the OR group ( P = .003). The vertical COR was slightly proximal in 66% of the HS group and 76% of the OR group ( P = .28). The median acetabular inclination angles of groups A and B were 41° and 40°, respectively ( P = .62). The median anteversion angle was 19° for both groups ( P = .89). Conclusions The horizontal COR was the only measurement with statistical significance. To conclude, ORs under supervision are as reliable as HSs to properly restore hip biomechanics in patients who undergo total hip arthroplasty for displaced femoral neck fractures.

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“…Learning curves, volume, operative time, and experience are well-documented confounders and have been shown to affect perioperative outcomes in orthopaedic surgery. [8][9][10][11][12] In 2016, Tang announced LOE would be reported in the methodology of novel techniques published in the Journal of Hand Surgery (Europe). 13 To evaluate the trend in documentation following the announcement, Massel et al reviewed LOE documentation in the Journal of Hand Surgery's Europe and American volumes from 2015 to 2019.…”

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confidence: 99%

Expertise of Surgeons Publishing Novel Techniques in the Journal of Wrist Surgery

et al. 2021

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Introduction Recent efforts to standardize reporting of surgeon experience in novel technique publications have recommended reporting of Tang level of expertise (LOE). Question/Purpose The aim of this study was to document trends in LOE reporting for novel technique articles published in the Journal of Wrist Surgery and evaluate whether author experience affects novel research outcomes. Methods A total of 261 articles published from 2018 to 2020 were reviewed. Articles describing novel surgical techniques were included and examined for Tang LOE. Author variables were collected online. Results Eight percent (21/261) of articles discussed novel surgical techniques and one reported LOE. Nearly half (47.6%) of articles did not conduct statistical analysis. Four (19.0%) reported insignificant statistical results and 7 (33.3%) reported significant findings. All significant statistical findings were positive. Number of prior related publications by the senior author did not affect new technique result significance (p = 0.34). Discussion From 2018 to 2020, only one article documented LOE. Authors' variables, including number of prior related publications, were not correlated with significant results in their new publications. This may suggest that an author's established experience in a novel technique, quantified by prior publications on the topic, does not make one more likely to achieve significantly better or worse outcomes in their reviewed Journal of Wrist Surgery study. Conclusions Tang LOE is an important way for readers to classify expertise and should be reported, and potentially modified to better define contributing variables.

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Is There an Influence of Surgeon’s Experience on the Clinical Course in Patients With a Proximal Femoral Fracture?

Cited by 8 publications

References 41 publications

Short-term outcome of isolated lateral malleolar fracture treatment is independent of hospital trauma volume or teaching status: a nationwide retrospective cohort study

Short-term outcome of isolated lateral malleolar fracture treatment is independent of hospital trauma volume or teaching status: a nationwide retrospective cohort study

Who Restores Hip Biomechanics More Effectively after a Femoral Neck Fracture? Comparison of Total Hip Arthroplasties Performed by Either Hip Surgeons or Orthopaedic Residents

Expertise of Surgeons Publishing Novel Techniques in the Journal of Wrist Surgery

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