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Hip fracture complication rate associated
with surgeon and hospital volume
#378. Presented at the American Academy of Orthopaedic Surgeons 75th Annual
Meeting. March 5-9, 2008. San Francisco.
SAN FRANCISCO - Hip fractures treated by surgeons who
annually performed a high volume of these cases resulted in
fewer in-hospital complications and less mortality than those
treated by low-volume surgeons, according to an analysis of data
from a nationwide database for almost 100,000 U.S. patients with
hip fractures.
"We found that low hospital volume was associated with an
increased odds ratio for infection, pneumonia, transfusion and
nonroutine discharge," said investigator James Andrew Browne,
MD.
Still, "Our data would suggest that mortality is more
associated with surgeon volume as opposed to hospital volume,"
he said.
To reinforce that finding, he said the risk of death or
pneumonia was greater when a surgeon only fixed zero to six hip
fractures annually.
Browne presented results of the retrospective cohort study
during the American Academy of Orthopaedic Surgeons 75th Annual
Meeting, here.
He and two colleagues extracted 97,894 hip fracture cases
from the Nationwide Inpatient Sample (NIS) database, which
included patients treated from 1988 to 2002 who were older than
55 years and did not have a pathologic fracture. Patients were
treated with open reduction internal fixation or hemi- or total
hip arthroplasty.
Investigators placed surgeons into three groups by their
annual hip fracture case volume. Low-volume surgeons completed
six or fewer cases. High-volume ones did more than 16 cases.
Hospitals were also grouped into three categories, where
low-volume providers completed fewer than 57 cases annually vs.
high-volume providers, who did more than 132 cases. |
