title: Influence of Surgeon Volume on Inpatient Complications, Cost, and Length of Stay Following Total Ankle Arthroplasty.
abstract: BACKGROUND
  Increased surgeon volume may be associated with improved outcomes following operative procedures. However, there is a lack of information on the effect of surgeon volume on inpatient adverse events and resource utilization following total ankle arthroplasty (TAA).
  
  
  METHODS
  A retrospective cohort study of TAA patients was performed using the Nationwide Inpatient Sample (NIS) from 2003 to 2009. High-volume surgeons were considered as those with volume ≥90th percentile of surgeons performing TAA. Multivariate regression was used to compare the rates of adverse events, hospital length of stay, and total hospital charges between surgeon volume categories.
  
  
  RESULTS
  A total of 4800 TAA patients were identified. The 90th percentile for surgeon volume was 21 cases per year. Mean length of stay was 2.8 ± 2.3 days and mean hospital charges were $45 963 ± $43 983. On multivariate analysis, high-volume surgeons had decreased overall complications (OR 0.5, P = .034) and rate of medial malleolus fracture (OR 0.1, P = .043), decreased length of stay (-0.9 days, P < .001), and decreased hospital charges (-$20 904, P < .001).
  
  
  CONCLUSIONS
  Surgeons with volume ≥90th percentile had a decreased rate of complications, decreased length of stay, and reduced hospital charges compared to other surgeons.
  
  
  METHODS
  Level III, comparative study.
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Bryce A
authors.initials: BA
authors.lastname: Basques
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Bitterman
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Campbell
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Haughom
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Johnny
authors.initials: J
authors.lastname: Lin
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA simon.lee@rushortho.com.
authors.forename: Simon
authors.initials: S
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058737:Arthroplasty, Replacement, Ankle / Q000009:adverse effects / Q000191:economics; D002983:Clinical Competence; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D000072161:Orthopedic Surgeons; D011183:Postoperative Complications; D012044:Regression Analysis; D012189:Retrospective Studies; D055815:Young Adult
keywords: cost; inpatient complications; length of stay; total ankle arthroplasty; total ankle replacement; volume