title: Does surgeon volume for total hip arthroplasty affect outcomes after hemiarthroplasty for femoral neck fracture?
abstract: We conducted a study to compare complication rates in patients treated with hemiarthroplasty for femoral neck fracture by surgeons with variable experience in primary total hip arthroplasty (THA) and revision THA. A cohort of Medicare beneficiaries (N = 115,352) was identified from Medicare part A claims from 1994 and 1995. All patients had undergone hemiarthroplasty for femoral neck fracture. Patients were grouped according to surgeon procedure volume (how many primary and revision THAs surgeon performed per year): 0 (no volume), 1-5 (low volume), 6-24 (mid volume), and 25+ (high volume). Claims were evaluated up to 5 years after surgery to identify patient encounters for complications, such as mortality, dislocation, and infection. Compared with patients treated by no-volume surgeons, patients treated by high-volume surgeons had significantly lower rates of mortality, prosthetic dislocation, and superficial infection. The difference was significant for mortality at 30 days (5.6% vs 6.5%), 90 days (10.8% vs 12.8%), and 1 year (22.3% vs 23.8%); for prosthetic dislocation at 1 year (1.2% vs 1.7%); and for superficial infection at 90 days (1.1% vs 1.6%), 1 year (1.4% vs 1.9%), and 5 years (1.5% vs 2.0%). Revision surgery rates, however, were statistically higher for the high-volume group than for the no-volume group at 90 days (0.9% vs 0.7%), 1 year (3.3% vs 2.9%), and 5 years (8.4% vs 7.7%). There were no differences in rates of venous thromboembolism or deep infection between the groups. Surgical experience in primary and revision THA has a significant effect on patient outcomes after hemiarthroplasty for femoral neck fracture.
authors.affiliation: Department of Orthopaedic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA. james.b.ames@hitchcock.org
authors.forename: James B
authors.initials: JB
authors.lastname: Ames
authors.forename: Jon D
authors.initials: JD
authors.lastname: Lurie
authors.forename: Ivan M
authors.initials: IM
authors.lastname: Tomek
authors.forename: Weiping
authors.initials: W
authors.lastname: Zhou
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Koval
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000401:mortality / Q000706:statistics & numerical data*; D002983:Clinical Competence; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D006278:Medicare; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D016526:Workload / Q000706:statistics & numerical data*