Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study

Abstract

Objectives To identify a cut point in annual surgeon volume associated with increased risk of complications after primary elective total hip arthroplasty and to quantify any risk identified.Design Propensity score matched cohort study. Setting Ontario, CanadaParticipants 37 881 people who received their first primary total hip arthroplasty during 2002-09 and were followed for at least two years after their surgery.Main outcome measure The rates of various surgical complications within 90 days (venous thromboembolism, death) and within two years (infection, dislocation, periprosthetic fracture, revision) of surgery.Results Multivariate splines were developed to visualize the relation between surgeon volume and the risk for various complications. A threshold of 35 cases a year was identified, under which there was an increased risk of dislocation and revision. 6716 patients whose total hip arthroplasty was carried out by surgeons who had done ≤35 such procedure in the previous year were successfully matched to patients whose surgeon had carried out more than 35 procedures. Patients in the former group had higher rates of dislocation (1.9% v 1.3%, P=0.006; NNH 172) and revision (1.5% v 1.0%, P=0.03; NNH 204).Conclusions In a cohort of first time recipients of total hip arthroplasty, patients whose operation was carried by surgeons who had performed 35 or fewer such procedures in the year before the index procedure were at increased risk for dislocation and early revision. Surgeons should consider performing 35 cases or more a year to minimize the risk for complications. Furthermore, the methods used to visualize the relationship between surgeon volume and the occurrence of complications can be easily applied in any jurisdiction, to help inform and optimize local healthcare delivery.

Association Between Surgeon Experience and Complication Rates in Adult Scoliosis Surgery

“…49 Sample and found that lower complication and mortality rates were associated with high hospital and surgeon volume and that the decrease in complications was more substantial with high surgeon volume than with high hospital volume. It is conceivable that experienced surgeons have been in practice longer and, therefore, have higher surgical volume.…”

Factors That Affect Outcome Following Total Joint Arthroplasty: a Review of the Recent Literature

“…Some of the variables that have been shown to affect the outcome after total joint replacement include social and demographic characteristics, medical comorbidities, and surgical technique [3][4][5][6][7]. Areas of continued active research include the effect of intrinsic factors such as obesity [8][9][10], cardiovascular disease [11,12], mental health disorders [13•, 14-17•, 18•, 19], hepatic disease [20, 21•, 22, 23•, 24], nutritional deficiencies [25-29•, 30], bone metabolic disease [31][32][33][34][35][36][37], and diabetes mellitus [38•, 39, 40], as well as external factors such as nicotine use [41,42], recent corticosteroid injections [43][44][45][46][47], and discharge disposition [48,49].…”

A skill degradation in laparoscopic surgery after a long absence: assessment based on nephrectomy case

“…Tables showing the patient background data and distribution of laparoscopic time were constructed. Second, the relationship between interval days and laparoscopic time was illustrated by adopting a method for restricted cubic spline curves, as a technique that allows flexible descriptions of non-linear relationships among variables [5,6] . Finally, multivariable linear regression analyses for laparoscopic time were performed with interval days and other adjusting variables including age, gender, comorbidity (in the form of the Charlson comorbidity index [7] ), oncological stage (according to the International Union Against Cancer [8] ), type of surgery (nephrectomy or nephroureterectomy), hospital academic status, and hospital volume.…”