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Outcome of hip resurfacing dependent on experience
The risk for revision was 66% greater in hospitals performing the fewest amount of cases.
LAS VEGAS — A new study links outcomes of hip resurfacing to the hospital volume of resurfacing cases and, thereby, the surgeon’s experience.
To evaluate the impact of operative volume on hip resurfacing outcomes, Andrew J. Shimmin, MBBS, FAOrthA, and colleagues used the Australian Joint Registry to identify nearly 9,000 hip resurfacings performed at 196 hospitals between September 1999 and December 2006. The investigators used revision as an endpoint for survivorship.
They found that 74% of hospitals performed fewer than 30 procedures during the 7-year study period, while 64% of hip resurfacings were performed at 16 “high-volume” hospitals, or those that performed more than 100 cases. Overall, the researchers found that 3.1% of resurfacings were revised.
Four groups
The investigators categorized the hospitals into the following four groups according to their volume of cases performed during the study period:
- fewer than 25 cases;
- 25-49 cases;
- 50-100 cases; and,
- more than 100 cases.
They then compared the cumulative rate of revision at 4 years among the hospital groups.
At 4 years, the investigators discovered a 6% revision rate for centers performing fewer than 25 cases, a 5.6% rate for those performing 25-49 cases, a 4.7% rate for hospitals doing 50-99 cases, and a 2.7% revision rate for those performing more than 100 cases. After adjusting for patient age and gender, the investigators discovered that the risk for revision was 66% greater in hospitals performing the fewest amount of cases.
Direct correlation
“In this study, hospital volume is primarily a reflection of the operative experience of the individual surgeons,” Shimmin said at the American Academy of Orthopaedic Surgeons 76th Annual Meeting, here.
“The outcome of hip resurfacing is strongly dependent on the experience of the surgeon and hospital performing the procedure. Even when adjusted for patients’ age and sex, the risk of revision at low-volume centers was 66% greater than a higher volume center. This supports the need for increased training of surgeons before undertaking hip resurfacing,” he said.
“Just looking a little bit into the future, these figures relate to every surgeon’s initial experience,” Shimmin added. “I think it is quite reasonable to conclude that outcomes will improve when residents have some training in the procedure as part of their resident training.”
For more information:Reference:
- Andrew J. Shimmin, MBBA, FAOrthA, can be reached at the Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Victoria 3181, Australia; e-mail: info@andrewshimmin.com.au. He is a paid consultant for Finsbury and has received research or institutional support from Smith & Nephew.
- Shimmin AJ. The effect of operative volume on the outcome of hip resurfacing. Paper #316. Presented at the American Academy of Orthopaedic Surgeons 76th Annual Meeting. Feb. 25-28, 2009. Las Vegas.