title: Trauma surgery by general surgeons: Still an option for proximal femoral fractures?
abstract: Surgery for proximal femoral fractures in the Netherlands is performed by trauma surgeons, general surgeons and orthopaedic surgeons. The aim of this study was to assess whether there is a difference in outcome for patients with proximal femoral fractures operated by trauma surgeons versus general surgeons. Secondly, the relation between hospital and surgeon volume and postoperative complications was explored.
  
  
  
  Patients of 18 years and older were included if operated for a proximal femoral fracture by a trauma surgeon or a general surgeon in two academic, eight teaching and two non-teaching hospitals in the Netherlands from January 2010 until December 2013. The combined endpoint was defined as reoperation or surgical site infection. Multivariate analysis was used to adjust for patient and fracture characteristics and hospital and surgeon volume. Categories for hospital volume were>170/year (high volume), 96-170/year (medium volume) and <96/year (low volume).
  
  
  
  In 4552 included patients 2382 (52.3%) had surgery by a trauma surgeon. Postoperative complications occurred in 276 (11.6%) patients operated by a trauma surgeon and in 258 (11.9%) operated by a general surgeon (p=0.751). When considering confounders in a multivariate analysis, surgery by trauma surgeons was associated with less postoperative complications (OR 0.746; 95%CI 0.580-0.958; p=0.022). Surgery in high volume hospitals was also associated with less complications (OR 0.997; 95%CI 0.995-0.999; p=0.012). Surgeon volume was not associated with complications (OR 1.008; 95%CI 0.997-1.018; p=0.175).
  
  
  
  Surgery by trauma surgeons and high hospital volume are associated with less reoperations and surgical site infections for patients with proximal femoral fractures.
authors.affiliation: Trauma Unit, Academic Medical Centre, Amsterdam, Netherlands. Electronic address: k.treskes@amc.nl.
authors.forename: Kaij
authors.initials: K
authors.lastname: Treskes
authors.affiliation: Department of traumasurgery, Vrije Universiteit Medical Centre, Amsterdam, Netherlands.
authors.forename: Stijn C
authors.initials: SC
authors.lastname: Voeten
authors.affiliation: Trauma Unit, Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: Maria C J M
authors.initials: MC
authors.lastname: Tol
authors.affiliation: Department of traumasurgery, Vrije Universiteit Medical Centre, Amsterdam, Netherlands.
authors.forename: Wietse P
authors.initials: WP
authors.lastname: Zuidema
authors.affiliation: Department of surgery, Spaarne Gasthuis Hospital, Haarlem, Netherlands.
authors.forename: Jefrey
authors.initials: J
authors.lastname: Vermeulen
authors.affiliation: Trauma Unit, Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
authors.affiliation: Department of surgery, Maasstad hospital, Rotterdam, Netherlands.
authors.forename: Niels W L
authors.initials: NW
authors.lastname: Schep
authors.affiliation: Medical Centre Alkmaar, Netherlands
authors.forename: JG Han
authors.initials: JGH
authors.lastname: van den Brand
authors.affiliation: Tergooi Hospital, Hilversum, Netherlands
authors.forename: Romuald
authors.initials: R
authors.lastname: van Velde
authors.affiliation: Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, Netherlands
authors.forename: Robert
authors.initials: R
authors.lastname: Haverlag
authors.affiliation: Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, Netherlands
authors.forename: Jan M
authors.initials: JM
authors.lastname: Ultee
authors.affiliation: MC Group, Lelystad, Netherlands
authors.forename: Victor A
authors.initials: VA
authors.lastname: Postma
authors.affiliation: BovenIJ Hospital, Amsterdam, Netherlands
authors.forename: Bas A
authors.initials: BA
authors.lastname: Twigt
authors.affiliation: Flevo Hospital, Almere, Netherlands
authors.forename: Bart A
authors.initials: BA
authors.lastname: van Dijkman
authors.affiliation: Waterland Hospital, Purmerend, Netherlands
authors.forename: Pieter
authors.initials: P
authors.lastname: Heres
authors.affiliation: Westfriesgasthuis Hospital, Hoorn, Netherlands
authors.forename: Jasper
authors.initials: J
authors.lastname: Winkelhagen
authors.affiliation: TraumaNet AMC, Netherlands
authors.forename: Mariska
authors.initials: M
authors.lastname: Klooster
authors.affiliation: Netwerk Acute Zorg VUmc, Netherlands
authors.forename: Annelies
authors.initials: EJ
authors.lastname: Toor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000592:standards*; D005260:Female; D005264:Femoral Fractures / Q000453:epidemiology / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods / Q000592:standards; D013502:General Surgery; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D019637:Orthopedic Procedures; D018579:Patient Selection; D011183:Postoperative Complications; D012086:Reoperation / Q000706:statistics & numerical data*; D066231:Surgeons; D013530:Surgical Wound Infection / Q000453:epidemiology*; D015599:Trauma Severity Indices; D016896:Treatment Outcome
keywords: General surgery; Hemiarthroplasty; Hip fractures; Hospital volume; Osteosynthesis; Postoperative complications; Proximal femoral fractures; Reoperation; Surgeon volume; Surgical site infection