Does Very High Surgeon or Hospital Volume Improve Outcomes for Hemiarthroplasty Following Femoral Neck Fractures? |
| |
| Institution: | 1. Department of Orthopaedics, The Ohio State University Wexner Medical Center, 725 Prior Hall, 376 W 10th Ave, Columbus, OH 43210, USA;2. Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA;3. College of Public Health, The Ohio State University, Columbus, OH, USA;1. Department for the Upper Extremity, Hand-, and Microsurgery, Immanuel Krankenhaus, Königstr. 63, 14109, Berlin, Germany;2. Center for Hand Surgery, Universitätsmedizin Greifswald, F.-Sauerbruch-Straße, 17475, Greifswald, Germany;3. Department for Hand-, Replantation- and Microsurgery, Unfallkrankenhaus Berlin, Warener Straße 7, 12683, Berlin, Germany |
| |
| Abstract: | BackgroundThis study evaluates whether very high-volume hip arthroplasty providers have lower complication rates than other relatively high-volume providers.MethodsHemiarthroplasty patients ≥60 years old were identified in the New York Statewide Planning and Research Cooperative System 2001-2015 dataset. Low-volume hospitals (<50 hip arthroplasty cases/y) and surgeons (<10 cases/y) were excluded. The upper and lower quintiles were compared for the remaining “high-volume” hospitals (50-70 vs >245) and surgeons (10-15 vs ≥60) using multivariable Cox proportional hazards regression. Multiple sensitivity analyses were performed treating volume as a continuous variable.ResultsIn total, 48,809 patients were included. Very high-volume hospitals demonstrated slightly less pneumonia (6% vs 7%, hazard ratio HR] 0.77, 95% confidence interval CI] 0.68-0.88, P < .0001). Very high-volume surgeons experienced slightly higher rates of inpatient morality (3% vs 2%, HR 1.30, 95% CI 1.06-1.60, P = .01), revision surgery (3% vs 3%, HR 1.24, 95% CI 1.02-1.52, P = .03), and implant failure (1% vs <1%, HR 1.80, 95% CI 1.10-2.96, P = .02). Sensitivity analyses did not significantly alter these findings but suggested that inpatient mortality may decline as surgeon volume approaches 30 cases/y before gradually increasing at higher volumes.ConclusionA clinically meaningful volume-outcome relationship was not identified among very high-volume hemiarthroplasty surgeons or hospitals. Although prior evidence indicates that outcomes can be improved by avoiding very low-volume providers, these results suggest that complications would not be further reduced by directing all hemiarthroplasty patients to very high-volume surgeons or facilities. Future research investigating whether inpatient mortality changes with surgeon volume (particularly around 30 cases/y) in a different dataset would be valuable.Level of EvidencePrognostic Level III. |
| |
| Keywords: | hip arthroplasty hemiarthroplasty volume-outcome relationship surgeon volume hospital volume very high volume |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
