Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, CA.
Departments of Epidemiology, and.
J Orthop Trauma. 2018 Jul;32(7):354-360. doi: 10.1097/BOT.0000000000001176.
To determine whether very low surgeon and hospital hip arthroplasty volumes are associated with unfavorable outcomes after hemiarthroplasty for femoral neck fractures.
Patients ≥60 years of age and who underwent hemiarthroplasty for femoral neck fracture were identified in the New York Statewide Planning and Research Cooperative System data from 2001 to 2015. Incidence of inpatient mortality and postoperative complications were compared across both surgeon and hospital volume using multivariable Cox proportional hazards regression, adjusting for clinical and demographic factors.
Fifty eight thousand eight hundred fourteen patients were included. Low surgeon volume (1 case/year) was associated with increased complications [hazard ratio (HR) 1.35, 95% CI, 1.26-1.44, P < 0.0001), including dislocations (HR 1.31 95% CI, 1.04-1.65, P = 0.02) and several medical complications (P = 0.003) compared with surgeons performing at least 2 hip arthroplasties/year. Low hospital volume (<20 cases/year) was associated with increased complications (HR 1.11, 95% CI, 1.02-1.20, P = 0.02), including deep infections (HR 1.39, 95% CI, 1.02-1.89, P = 0.04) and certain medical complications (P = 0.02) compared with centers performing at least 50 hip arthroplasties/year. Hospital and surgeon volume were not associated with inpatient mortality (P = 0.98) or reoperations (P = 0.40).
Providers who rarely perform hemiarthroplasty for femoral neck fractures should defer these cases to surgeons and hospitals who regularly perform hip arthroplasty. Additional research is needed to further characterize the thresholds for "low volume" and to determine whether there is additional benefit afforded by high-volume surgeons and hospitals (or if it is adequate that providers performing hemiarthroplasty maintain volumes above relatively low thresholds as identified here).
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
确定髋关节置换术医生和医院的极低手术量是否与股骨颈骨折半髋关节置换术后的不良结局有关。
在 2001 年至 2015 年纽约州规划与研究合作系统数据中，确定了年龄≥60 岁并接受股骨颈骨折半髋关节置换术的患者。使用多变量 Cox 比例风险回归比较了外科医生和医院手术量对住院死亡率和术后并发症的影响，调整了临床和人口统计学因素。
共纳入 58114 例患者。低外科医生手术量（1 例/年）与并发症增加相关[风险比（HR）1.35，95%置信区间（CI）1.26-1.44，P<0.0001]，包括脱位（HR 1.31，95%CI，1.04-1.65，P=0.02）和几种医疗并发症（P=0.003），与每年至少进行 2 例髋关节置换术的外科医生相比。低医院手术量（<20 例/年）与并发症增加相关（HR 1.11，95%CI，1.02-1.20，P=0.02），包括深部感染（HR 1.39，95%CI，1.02-1.89，P=0.04）和某些医疗并发症（P=0.02），与每年至少进行 50 例髋关节置换术的中心相比。医院和外科医生的手术量与住院死亡率（P=0.98）或再次手术（P=0.40）无关。
很少进行股骨颈骨折半髋关节置换术的医生应将这些病例转至经常进行髋关节置换术的外科医生和医院。需要进一步研究以更准确地确定“低量”的阈值，并确定高量外科医生和医院是否有额外的获益（或者是否足够的是，进行半髋关节置换术的医生保持高于此处确定的相对低阈值的手术量）。
预后 II 级。请参阅作者说明，以获取完整的证据水平描述。
