Higher surgeon volumes linked to lower risk: study
A team of researchers, including three from Sunnybrook, have found that patients whose hip replacement surgeries are performed by surgeons who do 35 or more hip replacement procedures per year have fewer complications and need for revision. The study was recently published in the BMJ.
“It’s been established that surgeons who perform a lot of a certain procedure gain technical skill and ability, and that usually translates into better results and fewer complications after surgery,” says Dr. Richard Jenkinson, an orthopaedic surgeon who was involved in the study. “But the biggest issue with the body of literature in this field is the question of ‘How many is enough?’”
The researchers analyzed data of patients who underwent hip replacement surgery between 2002 and 2009 and obtained a group of about 40,000 who had hip replacements for standard types of conditions. They were then able to determine which patients had surgery performed by surgeons who had high volumes and their outcomes.
“Using the data, the number that seems to be associated with better outcomes is about 35 hip replacements per year,” Dr. Jenkinson says. “People who did many more than 35 had about the same complication rates as those who performed at least 35. When surgeons did fewer than 35, you started to see increased complications and the need for revision, particularly when surgeons were performing much fewer than 35.”
The study also considered first-year surgeons.
“Of course, you have to start somewhere,” Dr. Jenkinson says. “So if a new surgeon has appropriate high-volume training in their residency and fellowship, they should be able to perform reasonably without complications.”
The study’s finding can help inform health-care policymakers and administrators to ensure surgeons have the resources to perform this volume of surgeries and maintain their competency, Dr. Jenkinson says. Surgeons should consider aiming to perform 35 cases or more per year, the authors wrote.
“Furthermore, the methods used to visualize the relationship between surgeon volume and the occurrence of complications can be easily applied in any jurisdiction, to help inform and optimize local healthcare delivery,” the authors concluded.
