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DGReview
Surgeon Volume Influences Rate of Total Hip Replacement
Revision
A DGReview of :"Early failures of total hip replacement:
Effect of surgeon volume"
Arthritis & Rheumatism
04/28/2004
By Emma Hitt, PhD
Patients treated by surgeons who perform few total hip
replacements (THR) per year are more likely to undergo
revision THR, particularly within the first 18 months of
surgery, than are patients treated by high-volume surgeons,
a new report suggests.
Hip prostheses function well for up to 20 years in at least
80% of patients, and failure rates are less than 1% per
year. However, it is unclear whether failure rates vary by
surgeon and hospital volumes.
Elena Losina, MD, with the Department of Biostatistics, at
the Boston University School of Public Health,
Massachusetts, United States, and colleagues investigated
whether provider volume was associated with revision rate of
THR.
The researchers evaluated the records of 57 488 Medicare
beneficiaries who underwent elective primary THR from
1995-1996 in 3044 hospitals in the United States. The
definition of primary THR failure was a subsequent revision
THR, determined in hospital claims by the International
Classification of Diseases Ninth Revision codes.
Hospitals were stratified based on volume: low (less than 25
THRs/year), medium (26-50, 51-100 THRs/year), and high (more
than 100 THRs/year). In addition, surgeons performing less
than 12 elective primary THRs annually in the Medicare
population were considered low volume.
A proportional hazard model was used to determine the
association between the rates of revision and surgeon
volume. Hospital volume, patient age, poverty status, sex,
and comorbidities were taken into account. The researchers
also examined whether there was a difference in revision
rate before and after 18 months based on surgeon volume.
Of the 57 488
patients who had elective primary THR in
1995-1996, 4.4% had at least 1 revision
THR by the end of 1999. Of those, 56.6%
occurred within the first 18 months.
"Further population-based studies are
needed to better understand the role of
the type of implant on this
association," Dr. Losina and colleagues
conclude. "In addition, studies are
needed to determine whether volume
influences later failure (e.g., after 10
years of followup)."
According to the researchers, clinicians
should consider surgeon volume among the
factors influencing their referrals for
elective THR.
Arthritis Rheum 2004;50:1338-1343.
"Early failures of total hip
replacement: Effect of surgeon volume"
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