Rajahraman Vinaya, Shichman Ittai, Berzolla Emily, Rozell Joshua, Meftah Morteza, Schwarzkopf Ran
Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA.
Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Arthroplast Today. 2023 Sep 19;23:101207. doi: 10.1016/j.artd.2023.101207. eCollection 2023 Oct.
Surgeons with high volume (HV) of total hip arthroplasty (THA) have seen better outcomes than low volume (LV) surgeons. However, literature regarding surgeon volume and outcomes in morbidly obese THA patients is scarce. This study examines the association between surgeon volume with THA in morbidly obese patients (body mass index ≥40) and their clinical outcomes.
We retrospectively reviewed all morbidly obese patients who underwent primary THA at our institution between March 2012 and July 2020 with 2 years of follow-up. Clinical outcomes were compared between the HV (HVa, top quartile of surgeons with the highest overall yearly THA volume) and LV (LVa) surgeons. Similar analysis was run comparing HV of morbidly obese THA (HVo, top quartile of surgeons with the highest yearly morbidly obese THA volume) and LV of morbidly obese THA (LVo) surgeons.
Six hundred and forty-three patients and 33 surgeons were included. HVa surgeons had significantly shorter length of stay and increased home discharge. HVa and HVo surgeons had significantly shorter operative times. There were no significant differences in overall 90-day major and minor complications or clinical differences in patient-reported outcomes. Revision rates and freedom from revisions did not differ between groups at 2-year follow-up.
HVa surgeons had significantly lower length of stay and operative times and increased discharge to home. There was no significant decrease in complications or revisions in either comparison model. Complications, revision rates, and patient satisfaction in morbidly obese patients who undergo THA may be independent of surgeon volume.
进行全髋关节置换术（THA）数量多的外科医生比数量少的外科医生取得了更好的治疗效果。然而，关于病态肥胖THA患者的外科医生手术量与治疗效果的文献却很匮乏。本研究探讨病态肥胖患者（体重指数≥40）中外科医生手术量与THA之间的关联及其临床疗效。
我们回顾性分析了2012年3月至2020年7月在本机构接受初次THA且有2年随访期的所有病态肥胖患者。比较了高手术量（HVa，每年THA总量最高的前四分之一外科医生）和低手术量（LVa）外科医生的临床疗效。对病态肥胖THA的高手术量（HVo，每年病态肥胖THA量最高的前四分之一外科医生）和病态肥胖THA的低手术量（LVo）外科医生进行了类似分析。
纳入了643例患者和33名外科医生。HVa外科医生的住院时间显著缩短，回家出院的比例增加。HVa和HVo外科医生的手术时间显著缩短。在90天内总体的主要和次要并发症方面或患者报告的结局方面没有显著差异。在2年随访时，各组之间的翻修率和无翻修情况没有差异。
HVa外科医生的住院时间和手术时间显著缩短，回家出院的比例增加。在任何一种比较模型中，并发症或翻修率均无显著降低。接受THA的病态肥胖患者的并发症、翻修率和患者满意度可能与外科医生手术量无关。
