The case for decreased surgeon-reported complications due to surgical volume and fellowship status in the treatment of geriatric hip fracture: An analysis of the ABOS database

Abstract

Introduction American orthopaedists are increasingly seeking fellowship sub-specialization. One proposed benefit of fellowship training is decrease in complications, however, few studies have investigated the rates of medical and surgical complications for hip fracture patients between orthopedists from different fellowship backgrounds. This study aims to investigate the effect of fellowship training and case volume on medical and surgical outcomes of patient following hip fracture surgical intervention. Methods 1999–2016 American Board of Orthopedic Surgery (ABOS) Part II Examination Case List data were used to assess patients treated by trauma or adult reconstruction fellowship-trained orthopedists versus all-other orthopaedists. Rates of surgeon-reported medical and surgical adverse events were compared between the three surgeon cohorts. Using binary multivariate logistic regression to control of demographic factors, independent factors were evaluated for their effect on surgical complications. Results Data from 73,427 patients were assessed. An increasing number of hip fractures are being treated by trauma fellowship trained surgeons (9.43% in 1999–2004 to 60.92% in 2011–2016). In multivariate analysis, there was no significant difference in type of fellowship, however, surgeons with increased case volume saw significantly decreased odds of complications (16–30 cases: OR = 0.91; 95% CI: 0.85–0.97; p = 0.003; 31+ cases: OR = 0.68; 95% CI: 0.61–0.76; p<0.001). Femoral neck hip fractures were associated with increased odds of surgical complications. Discussion Despite minor differences in incidence of surgical complications between different fellowship trained orthopaedists, there is no major difference in overall risk of surgical complications for hip fracture patients based on fellowship status of early orthopaedic surgeons. However, case volume does significantly decrease the risk of surgical complications among these patients and may stand as a proxy for fellowship training. Fellows required to take hip fracture call as part of their training regardless of fellowship status exhibited decreased complication risk for hip fracture patients, thus highlighting the importance of additional training.

Navigated intramedullary nailing for patients with intertrochanteric hip fractures is cost-effective at high-volume hospitals in mainland China: A markov decision analysis

“…Several researches have demonstrated that the lower surgical volumes were related to higher rates of complications and failures in hip fracture procedures and other orthopaedic surgeries ( 45 – 47 ). In IMN, experienced surgeons were able to insert screws more precisely than inexperienced surgeons ( 48 ).…”

“…CAOS: computerassisted orthopaedic system; IV: Inverse variance method; CI: confidence intervals; df: degrees of freedom. Several researches have demonstrated that the lower volumes were related to higher rates of complications and failures in hip fracture procedures and other orthopaedic surgeries (45)(46)(47). In IMN, experienced surgeons were able to insert screws more precisely than inexperienced surgeons (48).…”

Use of Direct-Acting Anticoagulants (DOAC) Among Hip Fracture Patients Is Not an Indication to Delay Surgical Intervention.

“…Between 2010 and 2018, 205 patients with hip fracture with a history of DOAC use were identified. The reported mean cohort age was 81.9 years (65-100 years), of whom 64% (132/205) were female, with a mean CCI of 6.4 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). The distribution of hip fracture pattern included 65% (133/ 205) femoral neck fractures, 26% (53/205) intertrochanteric fractures, 5% (10/205) subtrochanteric fractures, and 4% (9/ 205) other.…”

“…3,5 This rise is correlated with aging population, given that by 2050 the number of individuals to live to 85 years of age is predicted to more than quadruple. [6][7][8][9][10] The literature has consistently reported that delay in surgical fixation greater than 24 hours has been associated with increased risk of death within 30 days. 11 Furthermore, if delayed more than 48 hours, the risk of 1-year mortality increases 1.35-fold to 2-fold.…”