Population Health Sciences Institute, Newcastle upon Tyne, UK.
South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK.
Bone Joint J. 2024 Oct 1;106-B(10):1050-1058. doi: 10.1302/0301-620X.106B10.BJJ-2024-0347.R1.
This study evaluates the association between consultant and hospital volume and the risk of re-revision and 90-day mortality following first-time revision of primary hip arthroplasty for aseptic loosening.
We conducted a cohort study of first-time, single-stage revision hip arthroplasties (RHAs) performed for aseptic loosening and recorded in the National Joint Registry (NJR) data for England, Wales, Northern Ireland, and the Isle of Man between 2003 and 2019. Patient identifiers were used to link records to national mortality data, and to NJR data to identify subsequent re-revision procedures. Multivariable Cox proportional hazard models with restricted cubic splines were used to define associations between volume and outcome.
Among 12,961 RHAs there were 513 re-revisions within two years, and 95 deaths within 90 days of surgery. The risk of re-revision was highest for a consultant's first RHA (hazard ratio (HR) 1.56 (95% CI 1.15 to 2.12)) and remained significantly elevated for their first 24 cases (HR 1.26 (95% CI 1.00 to 1.58)). Annual consultant volumes of five/year were associated with an almost 30% greater risk of re-revision (HR 1.28 (95% CI 1.00 to 1.64)) and 80% greater risk of 90-day mortality (HR 1.81 (95% CI 1.02 to 3.21)) compared to volumes of 20/year. RHAs performed at hospitals which had cumulatively undertaken fewer than 167 RHAs were at up to 70% greater risk of re-revision (HR 1.70 (95% CI 1.12 to 2.59)), and those having undertaken fewer than 307 RHAs were at up to three times greater risk of 90-day mortality (HR 3.05 (95% CI 1.19 to 7.82)).
This study found a significantly higher risk of re-revision and early postoperative mortality following first-time single-stage RHA for aseptic loosening when performed by lower-volume consultants and at lower-volume institutions, supporting the move towards the centralization of such cases towards higher-volume units and surgeons.
本研究评估了顾问和医院数量与初次翻修初次全髋关节置换术治疗无菌性松动后再翻修和 90 天死亡率之间的关联。
我们对 2003 年至 2019 年期间在英格兰、威尔士、北爱尔兰和马恩岛的国家关节登记处（NJR）数据中记录的初次单阶段翻修髋关节置换术（RHA）进行了队列研究，这些手术是为无菌性松动而进行的。患者标识符用于将记录与国家死亡率数据相关联，并与 NJR 数据相关联，以识别随后的再翻修手术。使用受限立方样条的多变量 Cox 比例风险模型来定义数量与结果之间的关联。
在 12961 例 RHA 中，两年内有 513 例再次翻修，90 天内有 95 例死亡。顾问的第一例 RHA 再翻修的风险最高（危险比（HR）1.56（95%置信区间 1.15 至 2.12）），并且在前 24 例中仍然显著升高（HR 1.26（95%置信区间 1.00 至 1.58））。每年顾问的手术量为 5 例/年，与再翻修的风险增加近 30%（HR 1.28（95%置信区间 1.00 至 1.64））和 90 天死亡率增加 80%（HR 1.81（95%置信区间 1.02 至 3.21））相关，与每年 20 例手术量相比。在累计进行少于 167 例 RHA 的医院进行的 RHA，再翻修的风险增加高达 70%（HR 1.70（95%置信区间 1.12 至 2.59）），而进行少于 307 例 RHA 的医院，90 天死亡率增加高达三倍（HR 3.05（95%置信区间 1.19 至 7.82））。
本研究发现，初次单阶段 RHA 治疗无菌性松动时，由低容量顾问和低容量机构进行治疗，再翻修和术后早期死亡率的风险显著增加，这支持将此类病例向高容量单位和外科医生集中的趋势。
