Sunnybrook Health Sciences Centre, Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Orthopaedics Surgery, Siriraj Hospital, Mahidol University, Thailand
Sunnybrook Health Sciences Centre, Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada.
Acta Orthop. 2024 Sep 10;95:505-511. doi: 10.2340/17453674.2024.41506.
Total hip arthroplasty (THA) can be performed through various surgical approaches, including direct anterior (DAA). DAA-THA may offer faster recovery but carries a higher risk of complications, which may be mitigated by surgeon volume and experience. We examined the association of surgeons' annual surgical volume with major complications after DAA-THA in a population-based sample.
A population-based retrospective cohort study was carried out on primary DAA-THA patients in Ontario between April 2016 and March 2021. We used restricted cubic splines to visually define the association between annual DAA surgeon volume and the risk of major surgical complications (fractures, dislocations, infections, and revisions) within 1 year of surgery. We further compared the complication rates amongst different DAA volume categories (< 30, 30-60, and > 60 cases/year).
The study encompassed 9,672 DAA-THA patients (52% female, median age 67 years). We showed a sharp decline in the probability of complications as the surgical volume of DAA-THA increased within the lower range of 0-30 cases/year; the probability slightly increased after the surgical volume exceeded 60 cases/year. The overall complication rates were 3.09%, 2.24%, and 2.18% for the surgical experience group of < 30 cases/year, 30-60 cases/year, and > 60 cases/year, respectively.
There was an inverse relationship between surgical volume and complication rates in DAA-THA within the lower volume ranges. Maintaining a surgical volume of at least 30 DAA-THA cases/year can minimize complications, emphasizing the importance of surgical volume in this approach.
全髋关节置换术（THA）可通过多种手术入路进行，包括直接前入路（DAA）。DAA-THA 可能恢复更快，但并发症风险更高，手术医生的年手术量和经验可能会降低这种风险。我们在基于人群的样本中检查了外科医生年手术量与 DAA-THA 后主要并发症之间的关系。
在 2016 年 4 月至 2021 年 3 月期间，对安大略省进行的一项基于人群的回顾性队列研究中，对原发性 DAA-THA 患者进行了研究。我们使用限制立方样条来直观地定义年度 DAA 外科医生手术量与手术后 1 年内发生主要手术并发症（骨折、脱位、感染和翻修）的风险之间的关系。我们还比较了不同 DAA 量类别（<30、30-60 和>60 例/年）之间的并发症发生率。
该研究纳入了 9672 例 DAA-THA 患者（52%为女性，中位年龄 67 岁）。我们发现，随着 DAA-THA 手术量在 0-30 例/年的较低范围内增加，并发症的可能性急剧下降；手术量超过 60 例/年后，这种可能性略有增加。手术经验组<30 例/年、30-60 例/年和>60 例/年的总体并发症发生率分别为 3.09%、2.24%和 2.18%。
在较低的手术量范围内，DAA-THA 的手术量与并发症发生率呈反比关系。保持至少 30 例 DAA-THA/年的手术量可以最大限度地减少并发症，强调了手术量在这种方法中的重要性。
