title: Mortality and re-operation rate after proximal femoral fracture surgery by trainees.
abstract: OBJECTIVE
  To review records of 761 patients who underwent surgery for proximal femoral fractures to determine whether surgeon's experience and volume was associated with 6-month mortality and reoperation rates.
  
  
  METHODS
  Records of 761 patients who underwent surgery for proximal femoral fractures were reviewed. Patients operated on by a consultant or trainees with supervision of a scrubbed consultant were classified as the consultant group (n=214). Patients operated on by trainees alone (n=516) or trainees with supervision of an unscrubbed consultant (n=31) were classified as the trainee group (n=547). A total of 21 trainees were identified. They had different levels of experience, which was quantified according to the total number of operations performed for proximal femoral fractures from the start of their training to the start of the study.
  
  
  RESULTS
  Patients in the trainee group were older (80 ± 12 vs. 77 ± 14 years, p<0.001), and the fractures were more complex in the consultant group. The 6-month mortality rate was 24.2% (n=184). The odds of dying within 6 months after operation was 80% higher in patients operated on by trainees without supervision of a scrubbed consultant (odds ratio, 1.8; 95% confidence interval, 1.1-2.7). Variables associated with the 6-month mortality rate were age (p<0.001), American Society of Anesthesiologists grade (p<0.001), pre-injury activity level (p<0.001), and the surgeon's grade (p<0.05). The 6-month reoperation rate was 3.8% (n=29) and did not differ significantly in the 2 groups. The experience level of the trainees was not associated with the 6-month reoperation rate.
  
  
  CONCLUSIONS
  The odds of dying within 6 months after a surgery for proximal femoral fractures was 80% higher in patients operated on by trainees without supervision of a scrubbed consultant.
authors: Department of Orthopaedics and Trauma, Royal Lancaster Infirmary, United Kingdom.
authors: Aiman
authors: A
authors: Khunda
authors: Maya
authors: M
authors: Jafari
authors: Sulaiman
authors: S
authors: Alazzawi
authors: Alistair
authors: A
authors: Mountain
authors: Anthony C W
authors: AC
authors: Hui
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008297:Male; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies
keywords: femoral neck fractures; mortality; reoperation