Relative impact of hospital and surgeon procedure volumes on primary total hip arthroplasty revision: a nationwide cohort study in France

Abstract

BackgroundBoth surgeon and hospital procedure volumes have been found to be associated with total hip arthroplasty (THA) outcomes. However, little research has been conducted on the relative influence. We studied the association between THA survivorship and both hospital and surgeon procedure volumes, considering their relative impact.MethodsA population-based cohort included all patients aged ≥40 years having received a unilateral primary THA from 2010 to 2011, from the French National Health Insurance Database. Patients were followed up until the end of 2014. The outcome was THA revision. Exposures of interest were procedure volumes, divided into tertiles: <1.5, 1.5-4, >4 and <7, 7-15, >15 procedures per month defined as low, medium, and high volumes for surgeon and hospital, respectively.ResultsThe cohort had 62,906 patients, with mean age 69 years and women 57%. Mean surgeon and hospital volumes were 8 and 23 procedures per month, respectively, and 5%, 72%, 22% and 7%, 28%, 65% of THAs were implanted by a low-, medium-, and high-volume surgeon or in a low-, medium-, and high-volume hospital, respectively. Median follow-up was 45 months (range, 0-57 months). In multivariate analysis, adjusted for both surgeon and hospital volumes, for patient and THA characteristics, a lower surgeon volume was associated with poorer THA survivorship (adjusted hazard ratio [aHR] = 1.19; 95% confidence interval [CI], 1.07-1.34 and aHR = 1.70; 95% CI, 1.40-2.05, for medium- and low-volume surgeon, respectively, compared with that of high volume), whereas hospital volume was not.ConclusionsThis study brings evidence to support the notion that THAs performed by high-volume surgeons in French private hospitals have higher survivorship in the first 4 years.

A Clinico-Microbiological Study of Prosthetic Joint Infections in an Indian Tertiary Care Hospital: Role of Universal 16S rRNA Gene Polymerase Chain Reaction and Sequencing in Diagnosis

“…The cumulative PJI incidence at our hospital was 1.1% which is comparable with reports from other centres with high operative volume 21213. Various studies have shown that increase in the hospital operative volume results in fewer postoperative complications 1415. In addition, ultra-clean operating rooms, dedicated personnel, and improved surgical techniques contribute to the low incidence of PJI observed at our hospital.…”

Influence of Hospital Volume of Procedures by Year on the Risk of Revision of Total Hip and Knee Arthroplasties: A Propensity Score-Matched Cohort Study

“…Our study overcomes a few methodological limitations of previous research and shows that, nowadays in Catalonia, the volume of THA and TKA procedures performed in a hospital per year could be related to the incidence of revision. Contrary to previous research focused on other contexts carried out using unmatched cohorts [6,7,12,13,14], higher-volume hospitals could have a higher risk of revision in their primary prostheses than lower-volume centers in Catalonia.…”

“…In the lower-volume hospitals in Catalonia, usually only one surgeon performs each type of arthroplasty. Due to this, despite the lower volume by hospital, the volume by surgeon could be high, a factor that has been related to lower revision rates [13,14,22]. Further research using matched cohorts from different healthcare contexts, e.g., using data from different countries’ or cultures’ registers, using different cut-off values to divide between higher- and lower-volume groups, and accounting for surgeon and hospital-environment related variables, could help improve our understanding of how volume by year is related to the incidence of revision.…”

“…Previous studies have shown varying results when examining the relationship between the hospital volume by year and the risk of revision but after focusing on these results, the evidence found is inconsistent [6,7,8,9,10,11,12,13,14,15]. While some of them have not found any association between the hospital volume and the risk of revision [9,10,11], other studies have suggested a possible higher risk of revision for primary prostheses in lower volume hospitals over higher volume, both at medium- and long-term follow-up [6,7,12,13,14]. Differences in the results previously found might be related to the context of the study.…”

Total Hip Arthroplasty for Developmental Dysplasia of Hip vs Osteoarthritis: A Propensity Matched Pair Analysis

“…Third, there may be selection bias in our study because complex dysplasia cases are more likely to be performed by higher-volume and fellowship-trained surgeons. As surgeon volume and arthroplasty fellowship training are associated with lower complication rates, lower operative times, and improved outcomes [28][29][30][31][32][33][34][35][36], this would bias the dysplasia group to trend towards improved outcomes in comparison with the general OA cohort. Surgeon volume and fellowship training are not available via the NSQIP database which prevented stratification of this potential effect.…”