Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, United States of America.
Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, United States of America.
PLoS One. 2022 Feb 25;17(2):e0263475. doi: 10.1371/journal.pone.0263475. eCollection 2022.
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.
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.
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.
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.
越来越多的美国骨科医生正在寻求专科医师培训。 fellowship 培训的一个好处是减少并发症，然而，很少有研究调查不同 fellowship背景的骨科医生治疗髋部骨折患者的医疗和手术并发症发生率。本研究旨在调查 fellowship培训和病例量对髋部骨折手术干预后患者的医疗和手术结果的影响。
使用 1999-2016 年美国骨科医师学会（ABOS）第二期考试病例清单数据评估接受创伤或成人重建 fellowship 培训的骨科医生与所有其他骨科医生治疗的患者。比较三组外科医生报告的医疗和手术不良事件发生率。使用二元多变量逻辑回归来控制人口统计学因素，评估独立因素对手术并发症的影响。
评估了 73427 例患者的数据。接受创伤 fellowship培训的外科医生治疗的髋部骨折数量逐渐增加（1999-2004 年为 9.43%，2011-2016 年为 60.92%）。多变量分析显示， fellowship类型无显著差异，但病例量增加的外科医生并发症发生率显著降低（16-30 例：OR=0.91；95%CI：0.85-0.97；p=0.003；31+例：OR=0.68；95%CI：0.61-0.76；p<0.001）。股骨颈骨折与手术并发症的发生几率增加相关。
尽管不同 fellowship培训的骨科医生之间手术并发症的发生率存在微小差异，但根据早期骨科医生的 fellowship状况，髋部骨折患者的手术并发症总体风险没有明显差异。然而，病例量确实显著降低了这些患者手术并发症的风险，可能是 fellowship培训的代表。要求作为培训一部分接受髋部骨折呼叫的研究员，无论其 fellowship状况如何，髋部骨折患者的并发症风险均降低，因此突出了额外培训的重要性。
