The role of surgeon volume on patient outcome in total knee arthroplasty: a systematic review of the literatureReport as inadecuate




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BMC Musculoskeletal Disorders

, 13:250

Orthopedics and biomechanics

Abstract

BackgroundA number of factors have been identified as influencing total knee arthroplasty outcomes, including patient factors such as gender and medical comorbidity, technical factors such as alignment of the prosthesis, and provider factors such as hospital and surgeon procedure volumes. Recently, strategies aimed at optimizing provider factors have been proposed, including regionalization of total joint arthroplasty to higher volume centers, and adoption of volume standards. To contribute to the discussions concerning the optimization of provider factors and proposals to regionalize total knee arthroplasty practices, we undertook a systematic review to investigate the association between surgeon volume and primary total knee arthroplasty outcomes.

MethodsWe performed a systematic review examining the association between surgeon volume and primary knee arthroplasty outcomes. To be included in the review, the study population had to include patients undergoing primary total knee arthroplasty. Studies had to report on the association between surgeon volume and primary total knee arthroplasty outcomes, including perioperative mortality and morbidity, patient-reported outcomes, or total knee arthroplasty implant survivorship. There were no restrictions placed on study design or language.

ResultsStudies were variable in defining surgeon volume ‘low’: <3 to <52 total knee arthroplasty per year; ‘high’: >5 to >70 total knee arthroplasty per year. Mortality rate, survivorship and thromboembolic events were not found to be associated with surgeon volume. We found a significant association between low surgeon volume and higher rate of infection 0.26% - 2.8% higher, procedure time 165 min versus 135 min, longer length of stay 0.4 - 2.13 days longer, transfusion rate 13% versus 4%, and worse patient reported outcomes.

ConclusionsFindings suggest a trend towards better outcomes for higher volume surgeons, but results must be interpreted with caution.

KeywordsSurgeon volume Knee arthroplasty AbbreviationsTKATotal knee arthroplasty

THATotal hip arthroplasty

NSample size

USUnited States

HCUP-NISHealth Care Cost and Utilization Project Nationwide Inpatient Sample

OHIPOntario Health Insurance Plan

CIHICanadian Institute for Health Information

NHINational Health Insurance

PREZIESPreventie Ziekenhuisinfecties door Surveillance Network database

MRMortality rate

PEPulmonary embolism

DVTDeep venous thrombosis

WOMACWestern Ontario and McMaster Universities Osteoarthritis index

LOSLength of stay

OROdds ratio

LVLow volume

HVHigh volume.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2474-13-250 contains supplementary material, which is available to authorized users.

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Author: Rick L Lau - Anthony V Perruccio - Rajiv Gandhi - Nizar N Mahomed

Source: https://link.springer.com/







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