title: High-volume surgeons in regard to reductions in operating time, blood loss, and postoperative complications for total hip arthroplasty.
abstract: BACKGROUND
  The purpose of this study was to clarify the volume-outcome relations for total hip arthroplasty, with a particular focus on outcome variables such as operating time, blood loss, and postoperative complications.
  
  
  METHODS
  Using an Internet-based questionnaire survey, we identified 2965 total hip arthroplasties performed for osteoarthritis, idiopathic osteonecrosis of the femoral head, rheumatoid arthritis, or hip fractures in 289 hospitals in Japan during the period from November 1, 2006, to March 31, 2007. We examined the hospital and surgeon volumes, patient characteristics (age, sex, body mass index, diagnosis, drug history, co-morbid conditions), details of the surgical procedures, and outcome variables (operating time, blood loss, postoperative complications). Multivariate regression analyses were used to examine the relations between the outcome variables and hospital/surgeon volumes, adjusting for patient characteristics and surgical details.
  
  
  RESULTS
  The average operating time was 114 +/- 62 min. The average blood loss was 429 +/- 347 ml. The postoperative complication rate was 6.1%. Surgeon volume (> or = 500 cases) was inversely associated with operating time (odds ratio 0.20; P < 0.01), blood loss (odds ratio 0.54; P = 0.02), and postoperative complications (odds ratio 0.53; P = 0.01). Hospital volume was not significantly associated with any of the outcome variables examined.
  
  
  CONCLUSIONS
  The present study indicates that surgeon volume is a significant predictor of better outcomes after total hip arthroplasty.
authors.affiliation: Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Tsuchiya
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Matsuyama
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Ohe
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods / Q000534:rehabilitation; D016063:Blood Loss, Surgical; D002983:Clinical Competence; D015331:Cohort Studies; D004526:Efficiency; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D016526:Workload