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Van Dooren BJ, Bos P, Peters RM, Van Steenbergen LN, De Visser E, Brinkman JM, Schreurs BW, Zijlstra WP. Time trends in case-mix and risk of revision following hip and knee arthroplasty in public and private hospitals: a cross-sectional analysis based on 476,312 procedures from the Dutch Arthroplasty Register. Acta Orthop 2024; 95:307-318. [PMID: 38884413 PMCID: PMC11181924 DOI: 10.2340/17453674.2024.40906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 05/02/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND AND PURPOSE This study aims to assess time trends in case-mix and to evaluate the risk of revision and causes following primary THA, TKA, and UKA in private and public hospitals in the Netherlands. METHODS We retrospectively analyzed 476,312 primary arthroplasties (public: n = 413,560 and private n = 62,752) implanted between 2014 and 2023 using Dutch Arthroplasty Register data. We explored patient demographics, procedure details, trends over time, and revisions per hospital type. Adjusted revision risk was calculated for comparable subgroups (ASA I/II, age ≤ 75, BMI ≤ 30, osteoarthritis diagnosis, and moderate-high socioeconomic status (SES). RESULTS The volume of THAs and TKAs in private hospitals increased from 4% and 9% in 2014, to 18% and 21% in 2022. Patients in private hospitals were younger, had lower ASA classification, lower BMI, and higher SES compared with public hospital patients. In private hospitals, age and ASA II proportion increased over time. Multivariable Cox regression demonstrated a lower revision risk for primary THA (HR 0.7, CI 0.7-0.8), TKA (HR 0.8, CI 0.7-0.9), and UKA (HR 0.8, CI 0.7-0.9) in private hospitals. After initial arthroplasty in private hospitals, 49% of THA and 37% of TKA revisions were performed in public hospitals. CONCLUSION Patients in private hospitals were younger, had lower ASA classification, lower BMI, and higher SES com-pared with public hospital patients. The number of arthroplasties increased in private hospitals, with a lower revision risk compared with public hospitals.
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MESH Headings
- Humans
- Arthroplasty, Replacement, Knee/statistics & numerical data
- Arthroplasty, Replacement, Hip/statistics & numerical data
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/trends
- Netherlands/epidemiology
- Hospitals, Private/statistics & numerical data
- Male
- Female
- Hospitals, Public/statistics & numerical data
- Reoperation/statistics & numerical data
- Aged
- Middle Aged
- Registries
- Retrospective Studies
- Cross-Sectional Studies
- Diagnosis-Related Groups
- Risk Factors
- Aged, 80 and over
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Affiliation(s)
- Bart-Jan Van Dooren
- Department of Orthopedic Surgery, Medical Center Leeuwarden; Department of Orthopedic Surgery, Martini Hospital, Groningen.
| | - Pelle Bos
- Department of Orthopedic Surgery, Medical Center Leeuwarden
| | - Rinne M Peters
- Department of Orthopedic Surgery, Medical Center Leeuwarden; Department of Orthopedic Surgery, Martini Hospital, Groningen
| | | | - Enrico De Visser
- Department of Orthopedic Surgery, Canisius Wilhelmina Hospital, Nijmegen; Department of Orthopedic Surgery, Kliniek Orthoparc Rozendaal
| | | | - B Willem Schreurs
- Dutch Arthroplasty Register (LROI), 's Hertogenbosch; Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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Marcel AJ, Feinn RS, Myrick KM. Impact of Resident Involvement on 30-Day Postoperative Outcomes in Orthopedic Shoulder Surgery. Adv Orthop 2024; 2024:1550500. [PMID: 38586198 PMCID: PMC10999291 DOI: 10.1155/2024/1550500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 04/09/2024] Open
Abstract
The literature concerning resident involvement in shoulder surgery is limited. The purpose of this study was to examine whether resident involvement across all orthopedic shoulder surgeries is associated with adverse 30-day outcomes. Utilizing the American College of Surgeons National Surgical Quality Improvement Program database, patients who underwent shoulder surgery with or without a resident present were analyzed. Independent t-test and chi-square or Fischer's exact test were used appropriately. A logistic regression model was used to calculate adjusted odds ratios. This study examined 5,648 patients: 3,455 patients in the "Attending alone" group and 2,193 in the "Attending and resident in the operating room" group. Resident presence in the operating room was not associated with increased complications, except for bleeding transfusions (OR 1.71, CI 1.32-2.21, P ≤ 0.001). This study demonstrates that resident involvement in orthopedic shoulder surgery does not present an increased risk for 30-day complications when compared to surgeries performed with the attending surgeon alone.
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Affiliation(s)
- Aaron J. Marcel
- Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut, USA
| | - Richard S. Feinn
- Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut, USA
| | - Karen M. Myrick
- Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut, USA
- University of Saint Joseph, West Hartford, CT, USA
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Klag EA, Heil HO, Wesemann LD, Charters MA, North WT. Higher Annual Total Hip Arthroplasty Volume Decreases the Risk of Intraoperative Periprosthetic Femur Fractures. J Arthroplasty 2024; 39:138-144. [PMID: 37479197 DOI: 10.1016/j.arth.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 07/09/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Periprosthetic femur fracture (PFF) is a complication of total hip arthroplasty (THA). These occur intraoperatively or postoperatively, and documented risk factors of PFFs include women, age greater than 65 years, cementless stems, and inflammatory arthropathies. The aim of this retrospective cohort study was to assess the relationship of years of surgical experience and surgeon annual THA volume on intraoperative and postoperative PFFs. METHODS Data were collected from a database query, and PFFs were identified as either intraoperative or postoperative. Intraoperative and postoperative PFFs were both compared to a control group of non-PFF patients. Years of surgical experience at the time of surgery and annual THA volume for the primary surgeon were calculated for all cases. Logistic regression analyses were used to calculate odds ratios for each of the surgeon variables when adjusted for patient demographics. RESULTS Thirty-seven intraoperative and 108 postoperative PFFs were identified and compared to 7,629 controls. From regression analyses, high-volume surgeons (≥50 THA/year) had lower odds of intraoperative PFF (adjusted odds ratio (aOR) = 0.40, P = .020) but not postoperative PFF (aOR = 1.02, P = .921). Surgeon experience (≥15 years since board certification at the time of surgery), was not significantly related to either PFF outcomes. For patient factors, age ≥65 years (aOR = 2.30, P < .001) and women (aOR = 2.69, P < .001) were both significant predictors of postoperative PFFs only. CONCLUSION Surgeons who performed 50 or more THAs per year had significantly fewer intraoperative PFFs than surgeons who did less than 50 THAs per year. Surgeon experience was not significantly related to PFFs.
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Affiliation(s)
- Elizabeth A Klag
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Hailey O Heil
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Luke D Wesemann
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Michael A Charters
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Wayne T North
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
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The impact of surgical trainee involvement in total hip arthroplasty: a systematic review of surgical efficacy, patient safety, and outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1365-1409. [PMID: 35662374 DOI: 10.1007/s00590-022-03290-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Concerns persist that trainee participation in surgical procedures may compromise patient care and potentiate adverse events and costs. We aimed to analyse the potential impact and consequences of surgical trainee involvement in total hip arthroplasty (THA) procedures in terms of surgical efficacy, patient safety, and functional outcomes. METHODS We systematically reviewed Medline/PubMed, EMBASE, the Cochrane library, and Scopus databases in October 2021. Eligible studies reported a direct comparison between THA cases performed with and without trainee involvement. RESULTS Eighteen publications met our eligibility criteria and were included in our study. The included studies reported on 142,450 THAs completed on 142,417 patients. Specifically, 48,155 and 94,295 surgeries were completed with and without trainee involvement, respectively. The mean operative times for procedures with (n = 5,662) and without (n = 14,763) trainee involvement were 106.20 and 91.41 min, respectively. Mean overall complication rates were 6.43% and 5.93% for THAs performed with (n = 4842) and without (n = 12,731) trainees. Lastly, the mean Harris Hip Scores (HHS) for THAs performed with (n = 442) and without (n = 750) trainee participation were 89.61 and 86.97, respectively. CONCLUSION Our systematic review confirmed previous studies' reports of increased operative time for THA cases with trainee involvement. However, based on the overall similar complication rates and functional hip scores obtained, patients should be reassured concerning the relative safety of trainee involvement in THA. Future prospective studies with higher levels of evidence are still needed to reinforce the existing evidence.
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Fowler TJ, Aquilina AL, Reed MR, Blom AW, Sayers A, Whitehouse MR. The association between surgeon grade and risk of revision following total hip arthroplasty : an analysis of National Joint Registry data. Bone Joint J 2022; 104-B:341-351. [PMID: 35227094 DOI: 10.1302/0301-620x.104b3.bjj-2021-1389.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AIMS Total hip arthroplasties (THAs) are performed by surgeons at various stages in training with varying levels of supervision, but we do not know if this is safe practice with comparable outcomes to consultant-performed THA. Our aim was to examine the association between surgeon grade, the senior supervision of trainees, and the risk of revision following THA. METHODS We performed an observational study using National Joint Registry (NJR) data. We included adult patients who underwent primary THA for osteoarthritis, recorded in the NJR between 2003 and 2016. Exposures were operating surgeon grade (consultant or trainee) and whether or not trainees were directly supervised by a scrubbed consultant. Outcomes were all-cause revision and the indication for revision up to ten years. We used methods of survival analysis, adjusted for patient, operation, and healthcare setting factors. RESULTS We included 603,474 THAs, of which 58,137 (9.6%) procedures were performed by a trainee. There was no association between surgeon grade and all-cause revision up to ten years (crude hazard ratio (HR) 1.00 (95% confidence interval (CI) 0.94 to 1.07); p = 0.966), a finding which persisted with adjusted analysis. Fully adjusted analysis demonstrated an association between trainees operating without scrubbed consultant supervision and an increased risk of all-cause revision (HR 1.10 (95% CI 1.00 to 1.21); p = 0.045). There was an association between trainee-performed THA and revision for instability (HR 1.14 (95% CI 1.01 to 1.30); p = 0.039). However, this was not observed in adjusted models, or when trainees were supervised by a scrubbed consultant. CONCLUSION Within the current training system in England and Wales, appropriately supervised trainees achieve comparable THA survival to consultants. Trainees who are supervised by a scrubbed consultant achieve superior outcomes compared to trainees who are not supervised by a scrubbed consultant, particularly in terms of revision for instability. Cite this article: Bone Joint J 2022;104-B(3):341-351.
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Affiliation(s)
- Timothy J Fowler
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK
| | - Alex L Aquilina
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK
| | - Mike R Reed
- Department of Trauma and Orthopaedics, Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust, Ashington, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
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Saarensilta A, Juthberg R, Edman G, Ackermann PW. Effect of Surgeon Experience on Long-Term Patient Outcomes in Surgical Repair of Acute Achilles Tendon Rupture. Orthop J Sports Med 2022; 10:23259671221077679. [PMID: 35252464 PMCID: PMC8894962 DOI: 10.1177/23259671221077679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 11/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background: The effect of surgeon experience on patient outcomes after surgical Achilles tendon rupture (ATR) repair has so far been unknown. Purpose: To examine whether patient-reported and functional outcomes as well as adverse events after surgical ATR repair differ between orthopaedic specialist surgeons and resident surgeons. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively analyzed data from 295 patients treated with surgical ATR repair with standardized techniques. The level of surgeon experience (specialist vs resident) and number of adverse events (rerupture, infection, and deep venous thrombosis) were recorded. Patient-reported and functional outcomes were assessed 12 months postoperatively using the validated Achilles tendon total rupture score (ATRS) and the heel-rise test, respectively. Analysis of covariance was used to compare differences in outcomes between specialist surgeons and resident surgeons. Pearson chi-square or Fisher exact test was used for analysis of adverse events. Results: The mean ATRS at 12 months for patients operated on by resident surgeons was significantly higher compared with specialist surgeons (85.9 [95% CI, 80.3-91.5] vs 77.8 [95% CI, 73.8-81.9]; P = .028). In addition, the lateral difference (operated vs unoperated side) in mean total concentric work and number of heel-rise repetitions at 12 months was smaller in patients operated on by resident surgeons (P = .011 and 0.015, respectively). The number of adverse events did not differ significantly between the 2 groups. Conclusion: Resident surgeons achieved patient-reported and functional outcomes at least as good as those of specialist surgeons in surgical ATR repair, with a similar risk of adverse events.
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Affiliation(s)
- Annukka Saarensilta
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Robin Juthberg
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Edman
- Research and Development, Norrtälje Hospital, Tiohundra AB, Norrtälje, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Paul W. Ackermann
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopedic Surgery, Karolinska University Hospital, Stockholm, Sweden
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Accuracy of digital templating of uncemented total hip arthroplasty at a certified arthroplasty center: a retrospective comparative study. Arch Orthop Trauma Surg 2022; 142:2471-2480. [PMID: 33725193 PMCID: PMC9474525 DOI: 10.1007/s00402-021-03836-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/15/2021] [Indexed: 12/04/2022]
Abstract
INTRODUCTION To investigate the accuracy of preoperative digital templating for total hip arthroplasty (THA) at a certified arthroplasty center (EndoCert EPZmax). MATERIALS AND METHODS In a retrospective study design, we analysed 620 uncemented primary THAs for templating accuracy by comparing the preoperatively planned THA component size and the implanted size as documented by the surgeon. Templating was determined to be a) exact if the planned and the implanted component were the same size and b) accurate if they were exact ± one size. Moreover, we investigated factors that potentially influence templating accuracy: overweight and obesity (WHO criteria), sex, implant design, surgeon experience, preoperative diagnosis. Digital templating was done with MediCAD software. The Mann-Whitney U test and the Kruskal-Wallis test were used for statistical analysis. RESULTS Templating was exact in 52% of stems and 51% of cups and was accurate in 90% of the stems and 85% of the cups. Regarding the factors potentially influencing templating accuracy, the type of cup implant had a significant influence (p = 0.016). Moreover, greater accuracy of stem templating was achieved in female patients (p = 0.004). No such effect was determined for the other factors investigated. CONCLUSIONS We conclude that preoperative 2D templating is accurate in 90% of the stems and 85% of the cups. Greater accuracy may be achieved in female patients. In addition to gender, the type of implant used may influence planning accuracy as well. Surgeon experience, BMI and preoperative diagnosis did not influence templating accuracy. LEVEL OF EVIDENCE Level III (retrospective comparative study with prospective cohort).
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Halonen LM, Stenroos A, Vasara H, Kosola J. Intramedullary Fixation of Trochanteric Fractures Can Be Safely Performed by Senior Residents Without Immediate Consultant Supervision. JOURNAL OF SURGICAL EDUCATION 2022; 79:260-265. [PMID: 34301521 DOI: 10.1016/j.jsurg.2021.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/16/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To assess the safety of senior residents performing trochanteric hip fracture surgery without immediate consultant supervision DESIGN: A retrospective chart review of trochanteric hip fractures (AO-OTA 31-A) operated in a single center between years 2011 and 2016 (inclusive). Operations were divided into three groups: Group 1 - surgeon was a senior resident without any immediate supervision; Group 2 - surgeon was a consultant and Group 3 - surgeon was a senior resident supervised by a consultant. The follow-up period was a minimum of 2 years or until death. All re-operations and surgical related mortality were assessed. SETTING Helsinki University Hospital, Finland. A tertiary level trauma center. PARTICIPANTS 987 consecutive trochanteric fractures on 966 patients treated by operative fixation of an intertrochanteric fracture with an intramedullary nail between 2011and 2016 (inclusive). RESULTS The total number of reoperations was smaller in Group 1 where the surgeon was a senior resident without any immediate supervision compared to Group 2 where the surgeon was a consultant (5.5 % vs 8.8 %, p < 0.05). There were no significant differences in mortality or length of surgery. The total rate of mechanical complications was 2.0 %, with no significant differences between groups. The observed blade cut-out rate was low: 1.3 %, suggesting a good overall quality of surgery. CONCLUSIONS Senior residents can safely perform intramedullary nailing of trochanteric fractures without immediate supervision.
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Affiliation(s)
- Lauri M Halonen
- South Karelia Central Hospital, Department of Orthopedics and Traumatology, and University of Helsinki, Lappeenranta, Finland.
| | - Antti Stenroos
- Helsinki University Hospital, Department of Orthopedics and Traumatology, and University of Helsinki, Helsinki, Finland
| | - Henri Vasara
- Helsinki University Hospital, Department of Orthopedics and Traumatology, and University of Helsinki, Helsinki, Finland
| | - Jussi Kosola
- Kanta-Häme Central Hospital, Department of Orthopedics and Traumatology, Hämeenlinna, Finland
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Fowler TJ, Aquilina AL, Blom AW, Sayers A, Whitehouse MR. Association between surgeon grade and implant survival following hip and knee replacement: a systematic review and meta-analysis. BMJ Open 2021; 11:e047882. [PMID: 34758989 PMCID: PMC8587578 DOI: 10.1136/bmjopen-2020-047882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To investigate the association between surgeon grade (trainee vs consultant) and implant survival following primary hip and knee replacement. DESIGN A systematic review and meta-analysis of observational studies. DATA SOURCES MEDLINE and Embase from inception to 6 October 2021. SETTING Units performing primary hip and/or knee replacements since 1990. PARTICIPANTS Adult patients undergoing either a primary hip or knee replacement, predominantly for osteoarthritis. INTERVENTION Whether the surgeon recorded as performing the procedure was a trainee or not. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was net implant survival reported as a Kaplan-Meier survival estimate. The secondary outcome was crude revision rate. Both outcomes were reported according to surgeon grade. RESULTS Nine cohort studies capturing 4066 total hip replacements (THRs), 936 total knee replacements (TKRs) and 1357 unicompartmental knee replacements (UKRs) were included (5 THR studies, 2 TKR studies and 2 UKR studies). The pooled net implant survival estimates for THRs at 5 years were 97.9% (95% CI 96.6% to 99.2%) for trainees and 98.1% (95% CI 97.1% to 99.2%) for consultants. The relative risk of revision of THRs at 5 and 10 years was 0.88 (95% CI 0.46 to 1.70) and 0.68 (95% CI 0.37 to 1.26), respectively. For TKRs, the net implant survival estimates at 10 years were 96.2% (95% CI 94.0% to 98.4%) for trainees and 95.1% (95% CI 93.0% to 97.2%) for consultants. We report a narrative summary of UKR outcomes. CONCLUSIONS There is no strong evidence in the existing literature that trainee surgeons have worse outcomes compared with consultants, in terms of the net survival or crude revision rate of hip and knee replacements at 5-10 years follow-up. These findings are limited by the quality of the existing published data and are applicable to countries with established orthopaedic training programmes. PROSPERO REGISTRATION NUMBER CRD42019150494.
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Affiliation(s)
- Timothy J Fowler
- Musculoskeletal Research Unit, Learning and Research Building, Southmead Hospital, University of Bristol Medical School, Bristol, UK
| | - Alex L Aquilina
- Musculoskeletal Research Unit, Learning and Research Building, Southmead Hospital, University of Bristol Medical School, Bristol, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Learning and Research Building, Southmead Hospital, University of Bristol Medical School, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, National Institute for Health Research, Bristol, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, Learning and Research Building, Southmead Hospital, University of Bristol Medical School, Bristol, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Learning and Research Building, Southmead Hospital, University of Bristol Medical School, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, National Institute for Health Research, Bristol, UK
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MacDonald DRW, Dougall TW, Mitchell M, Farrow L. Can Total Hip Arthroplasty for Hip Fracture Be Safely Performed by Trainees? A Retrospective Cohort Study. J Arthroplasty 2020; 35:1303-1306. [PMID: 31911092 DOI: 10.1016/j.arth.2019.12.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/19/2019] [Accepted: 12/13/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND No research is available comparing trainee and consultant outcomes for total hip arthroplasty (THA) for hip fracture. The aim of our study is to determine whether trainee-performed and consultant-performed THA produced equivalent radiological outcomes and complication rates for this patient cohort. METHODS We performed a retrospective cohort study at our institution, with inclusion of patients who underwent a primary THA for hip fracture between March 30, 2017 and February 07, 2019. Relevant perioperative and outcome data were collected through electronic records. Radiological outcomes were assessed by 2 independent reviewers. Follow-up was performed until August 07, 2019. RESULTS Eighty-seven patients were included in the study. The mean length of follow-up was 13 months (range, 6-29). Forty-three patients underwent consultant-led operations and 44 underwent trainee-performed (ST3-ST8) operations under consultant supervision. There were no significant differences between the 2 groups regarding complication risk (no recorded dislocation, infection requiring reoperation, revision or 30-day mortality in either group). There were also no significant differences between trainees and consultants regarding the radiological outcomes of mean acetabular component inclination (37.2° vs 36.7°, respectively, P = .74); offset difference (+7.1 mm vs +7.2 mm, respectively, P = .91); leg length difference (+6.4 mm vs +5.7 mm, respectively, P = .56); and barrack grade for femoral cement mantle. CONCLUSION This study suggests that radiological and safety outcomes for trainees performing THA for hip fracture with appropriate supervision are equivalent to consultant surgeons. However, given the low event rate of complications, a larger study is required to determine whether there is any statistically significant difference.
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Giordano L, Oliviero A, Peretti GM, Maffulli N. The presence of residents during orthopedic operation exerts no negative influence on outcome. Br Med Bull 2019; 130:65-80. [PMID: 31049559 DOI: 10.1093/bmb/ldz009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 02/05/2019] [Accepted: 03/26/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Operative procedural training is a key component of orthopedic surgery residency. It is unclear how and whether residents participation in orthopedic surgical procedures impacts on post-operative outcomes. SOURCES OF DATA A systematic search was performed to identify articles in which the presence of a resident in the operating room was certified, and was compared with interventions without the presence of residents. AREAS OF AGREEMENT There is a likely beneficial role of residents in the operating room, and there is only a weak association between the presence of a resident and a worse outcome for orthopedic surgical patients. AREAS OF CONTROVERSY Most of the studies were undertaken in USA, and this represents a limit from the point of view of comparison with other academic and clinical realities. GROWING POINT The data provide support for continued and perhaps increased involvement of resident in orthopedic surgery. AREAS OF RESEARCH To clarify the role of residents on clinically relevant outcomes in orthopedic patients, appropriately powered randomized control trials should be planned.
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Affiliation(s)
- Lorenzo Giordano
- Department of Musculoskeletal Disorder, Faculty of Medicine and Surgery, University of Salerno, Salerno Italy
| | - Antonio Oliviero
- Department of Musculoskeletal Disorder, Faculty of Medicine and Surgery, University of Salerno, Salerno Italy
| | | | - Nicola Maffulli
- Department of Musculoskeletal Disorder, Faculty of Medicine and Surgery, University of Salerno, Salerno Italy.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK.,Institute of Science and Technology in Medicine, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, UK
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Harris I, Cuthbert A, Lorimer M, de Steiger R, Lewis P, Graves SE. Outcomes of hip and knee replacement surgery in private and public hospitals in Australia. ANZ J Surg 2019; 89:1417-1423. [PMID: 31069924 DOI: 10.1111/ans.15154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/16/2019] [Accepted: 02/24/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study determined the contributing factors of hospital sector (private versus public) variation in revision rates after elective total hip replacement (THR) for hip fracture, and elective total knee replacement (TKR). METHODS Using data from a large national arthroplasty registry, funnel plots for hospitals were generated, displaying the proportion of revised primary procedures. The proportion of outliers for each distribution was defined as the proportion outside the upper 99.7% confidence limit. Survival analyses determined differences between hospital sector revision rates separately for implants with the lowest revision rate, and for all other implants. Multivariate Cox regression determined the role of hospital sector in revision, adjusting for possible confounders. RESULTS For THR performed for osteoarthritis, 17.4% of private and 4.4% of public hospitals were outliers. For TKR performed for osteoarthritis, 19.6% of private and 10.0% of public hospitals were outliers. For THR for fractured neck of femur, 8.1% of private and 0.0% of public hospitals were outliers. Adjusted and unadjusted Kaplan-Meier analyses showed higher THR revision rates in private hospitals for osteoarthritis and fractured neck of femur, but no difference when restricted to the 10 prostheses with the lowest revision rate. The Kaplan-Meier analysis of TKR showed higher revision rates for private hospitals, with the association reversing when restricted to prostheses with the lowest revision rate. CONCLUSIONS Considerable variation was seen in the revision rate after THR and TKR between hospital sectors in Australia. The variation was largely due to differences in prosthesis selection.
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Affiliation(s)
- Ian Harris
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia.,Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Alana Cuthbert
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Richard de Steiger
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia.,Department of Surgery, Epworth HealthCare, Melbourne, Victoria, Australia
| | - Peter Lewis
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
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Singh P, Madanipour S, Fontalis A, Bhamra JS, Abdul-Jabar HB. A systematic review and meta-analysis of trainee- versus consultant surgeon-performed elective total hip arthroplasty. EFORT Open Rev 2019; 4:44-55. [PMID: 30931148 PMCID: PMC6404792 DOI: 10.1302/2058-5241.4.180034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Total hip arthroplasty (THA) is one of the most commonly performed orthopaedic procedures. Some concern exists that trainee-performed THA may adversely affect patient outcomes. The aim of this meta-analysis was to compare outcomes following THA performed by surgical trainees and consultant surgeons. A systematic search was performed to identify articles comparing outcomes following trainee- versus consultant-performed THA. Outcomes assessed included rate of revision surgery, dislocation, deep infection, mean operation time, length of hospital stay and Harris Hip Score (HHS) up to one year. A meta-analysis was conducted using odds ratios (ORs) and weighted mean differences (WMDs). A subgroup analysis for supervised trainees versus consultants was also performed. The final analysis included seven non-randomized studies of 40 810 THAs, of which 6393 (15.7%) were performed by trainees and 34 417 (84.3%) were performed by consultants. In total, 5651 (88.4%) THAs in the trainee group were performed under supervision. There was no significant difference in revision rate between the trainee and consultant groups (OR 1.09; p = 0.51). Trainees took significantly longer to perform THA compared with consultants (WMD 12.9; p < 0.01). The trainee group was associated with a lower HHS at one year compared with consultants (WMD -1.26; p < 0.01). There was no difference in rate of dislocation, deep infection or length of hospital stay between the two groups. The present study suggests that supervised trainees can achieve similar clinical outcomes to consultant surgeons, with a slightly longer operation time. In selected patients, trainee-performed THA is safe and effective.
Cite this article: EFORT Open Rev 2019;4:44-55. DOI: 10.1302/2058-5241.4.180034.
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Patient outcomes following carotid endarterectomy are not adversely affected by surgical trainees' operative involvement: A retrospective cohort study. Ann Med Surg (Lond) 2019; 39:1-4. [PMID: 30733862 PMCID: PMC6357689 DOI: 10.1016/j.amsu.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 01/06/2019] [Accepted: 01/14/2019] [Indexed: 11/23/2022] Open
Abstract
Background Surgical training is an increasingly controversial topic. Concerns have been raised about both training opportunities becoming scarcer and poorer outcomes in operations led by surgical trainees; despite the evidence base for this being mixed. This retrospective cohort study aims to compare outcomes following carotid endarterectomy in patients who were operated on by a surgical trainee to those operated on by consultants. Materials and methods Consecutive patients, who underwent carotid endarterectomy between 01/06/2012 and 1/12/2016, were entered into a prospectively maintained database. Patients were grouped according to whether a consultant or trainee vascular surgeon was the lead operating surgeon. Outcomes were 30-day mortality, 30-day stroke rate, operation time and complication rate. Results One-hundred-and-twenty-one patients, with a mean age of 70.3 years, underwent carotid endarterectomy over a 4.5-year period. They were classified by the grade of the lead operating surgeon: consultant (n = 74) or registrar (n = 47). The median operative time was 117 min for consultants and 115 min for registrars with no significant difference between the two groups (p = 0.78). Three patients died in the post-op period, 2 secondary to post-operative stroke and a further 5 had nonfatal strokes. Grade of surgeon was also found to have no impact on 30- day mortality (p = 0.99) or stroke rate (p = 0.99). Sixty-six patients experienced post-operative complications, of varying severity, but no significant difference (p = 0.66) was found in incidence between trainee (57%) and consultant (53%) groups. Conclusion Trainee involvement in carotid endarterectomy, with consultant supervision, leads to equivalent outcomes and represents a safe and useful training opportunity. There is a paucity of contemporary research assessing the safety of trainee involvement in carotid endarterectomy. Complication rates were higher for trainees but major complications were more common with consultant led operations. 30-day mortality is slightly higher in patients operated on by a consultant but not significantly so. Carotid endarterectomy can represent a safe and useful training opportunity for an appropriately supervised trainee.
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15
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Holzer LA, Scholler G, Wagner S, Friesenbichler J, Maurer-Ertl W, Leithner A. The accuracy of digital templating in uncemented total hip arthroplasty. Arch Orthop Trauma Surg 2019; 139:263-268. [PMID: 30523444 PMCID: PMC6373540 DOI: 10.1007/s00402-018-3080-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Preoperative planning is an essential part of total hip arthroplasty (THA). It facilitates the surgical procedure, helps to provide the correct implant size and aims at restoring biomechanical conditions. In recent times, surgeons rely more and more on digital templating techniques. Although the conversion to picture archiving and communication system had many positive effects, there are still problems that have to be taken into consideration. OBJECTIVES The core objective was to evaluate the impact of the planners' experience on the accuracy of predicting component size in digital preoperative templating of THA. In addition, the influence of overweight and obesity (according to WHO-criteria), patient's sex and component design on the accuracy of preoperative planning have been analysed. MATERIALS AND METHODS The retrospective study included 632 consecutive patients who had primary uncemented THA. Digital templating was done using "syngo-EndoMap" software by Siemens Medical Solutions AG. Mann-Whitney U test and Kruskal-Wallis test have been used for statistical analysis. The accuracy of predicting component size has been evaluated by comparing preoperative planned sizes with implanted sizes as documented by the surgeons. The planner's experience was tested by comparing the reliability of preoperative planning done by senior surgeons or residents. The influence of BMI on predicting component size has been tested by comparing the accuracy of digital templating between different groups of BMI according to WHO-criteria. The same procedure has been done for evaluating the impact of patient´s sex and component design. RESULTS The implant size was predicted exactly in 42% for the femoral and in 37% for the acetabular component. 87% of the femoral components and 78% of the acetabular cups were accurate within one size. Digital templating of femoral implant size was significantly more reliable when done by a senior surgeon. No difference was found for the acetabular component sizes. The BMI also had an impact on estimating the correct femoral implant size. In overweight patients, planning was significantly more inaccurate than normal weight people. Differences were seen in obese patients. However, these were not significant. Accuracy of acetabular components was not affected. The design of the prostheses and the patient's sex had no influence on predicting component size. CONCLUSIONS Inexperience and overweight are factors that correlate with inaccuracy of preoperative digital templating in femoral components, whereas acetabular components seem to be independent of these factors.
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Affiliation(s)
- Lukas A. Holzer
- 0000 0000 8988 2476grid.11598.34Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria ,AUVA Trauma Center Klagenfurt, Klagenfurt am Wörthersee, Austria
| | - Georg Scholler
- 0000 0000 8988 2476grid.11598.34Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria ,grid.459693.4Department of Traumatology, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Stefan Wagner
- 0000 0001 1941 5140grid.9970.7Department of Sociology, Johannes Keppler University Linz, Linz, Austria
| | - Jörg Friesenbichler
- 0000 0000 8988 2476grid.11598.34Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Werner Maurer-Ertl
- 0000 0000 8988 2476grid.11598.34Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Andreas Leithner
- 0000 0000 8988 2476grid.11598.34Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
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Cowley RJ, Frampton C, Young SW. Operating time for total knee arthroplasty in public versus private sectors: where does the efficiency lie? ANZ J Surg 2018; 89:53-56. [DOI: 10.1111/ans.14905] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 07/24/2018] [Accepted: 09/07/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Richard J. Cowley
- Department of Orthopaedics; Christchurch Hospital; Christchurch New Zealand
| | - Chris Frampton
- Department of Medicine; University of Otago; Dunedin New Zealand
| | - Simon W. Young
- Department of Orthopaedic Surgery; The University of Auckland; Auckland New Zealand
- Department of Orthopaedics; North Shore Hospital; Auckland New Zealand
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Storey R, Frampton C, Kieser D, Ailabouni R, Hooper G. Does Orthopaedic Training Compromise the Outcome in Knee Joint Arthroplasty? JOURNAL OF SURGICAL EDUCATION 2018; 75:1292-1298. [PMID: 29574018 DOI: 10.1016/j.jsurg.2018.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 01/05/2018] [Accepted: 02/21/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE This study investigates knee joint arthroplasty and compares the outcomes between attending (consultant) orthopedic surgeons and resident (trainee) surgeons. DESIGN Retrospective review and comparison of knee joint arthroplasty outcomes between 4 surgeon groups (attending, supervised senior and junior residents, and unsupervised senior residents). Measured outcomes were implant survival (revision rate) and patient reported functional outcomes, measured by Oxford knee score (OKS). SETTING New Zealand arthroplasty service. PARTICIPANTS Seventeen years of knee joint arthroplasty data from the New Zealand Joint Registry (NZJR) was reviewed. RESULTS The New Zealand Joint Registry (NZJR) data showed 79,671 total knee arthroplasties (TKA) and 8854 unicompartmental knee arthroplasties (UKA) performed between 1999 and 2016. Attending surgeons performed 90% and 97% of TKA and UKA, respectively. The number and proportion of resident performed knee joint arthroplasty has decreased. Faster operation times was observed in the attending surgeon group. Attending surgeon revision rate was 0.49 and 1.19/100 component years for TKA and UKA, respectively, this was not significantly increased in resident surgeon groups. Postoperative OKS was 37.7 and 39.7 for attending surgeon performed TKA and UKA, respectively. Mean OKS were less than 2 points worse in resident groups (resident range: 36.3-36.9) compared to attending colleagues for TKA, but for UKA scores were up to 11 points worse (resident range: 28.9-38.8). CONCLUSIONS New Zealand has a high rate of attending surgeon performed TKA and UKA. Revision rates were not increased in resident surgeon groups. Postoperative function was not reduced by a clinically significant amount in TKA in any of the resident surgeon groups but was reduced in supervised junior resident and unsupervised senior resident surgeon groups for UKA.
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Affiliation(s)
- Richard Storey
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand.
| | - Chris Frampton
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - David Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Ramez Ailabouni
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Gary Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
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Jolbäck P, Rolfson O, Mohaddes M, Nemes S, Kärrholm J, Garellick G, Lindahl H. Does surgeon experience affect patient-reported outcomes 1 year after primary total hip arthroplasty? Acta Orthop 2018; 89:265-271. [PMID: 29508643 PMCID: PMC6055771 DOI: 10.1080/17453674.2018.1444300] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Several studies have reported on the influence of various factors on patient-reported outcomes (PROs) after total hip arthroplasty (THA), but very few have focused on the experience of the surgeon. We investigated any association between surgeons' experience and PROs 1 year after primary THA. Patients and methods - Patient characteristics and surgical data at 10 hospitals in western Sweden were linked with PROs (EQ-5D-3L, Satisfaction Visual Analogue Scale (VAS), Pain VAS). These data were retrieved from the Swedish Hip Arthroplasty Register (SHAR). The surgeon's level of experience was divided into 4 subgroups related to experience: < 8 years, 8-15 years, and >15 years of clinical practice after specialist certificate. If no specialist certificate was obtained the surgery was classified as a trainee surgery. Surgeons with >15 years' experience as an orthopedic specialist were used as reference group in the analyses. Results - 8,158 primary THAs due to osteoarthritis were identified. We identified the surgeons' level of experience in 8,116 THAs. Data from SHAR on pre- and postoperative PROs and satisfaction at 1 year were available for 6,713 THAs. We observed a statistically significant difference among the 4 groups of surgeons regarding mean patient age, ASA classification, Charnley classification, diagnosis, and fixation technique. At 1-year follow-up, there were no statistically significant differences in Pain VAS, EQ-5D index, or EQ VAS among the subgroups of orthopedic specialists. Patients operated on by orthopedic trainees reported less satisfaction with the result of the surgery compared with the reference group. Interpretation - These findings indicate that patients can expect similar health improvements, pain reduction, and satisfaction 1 year after a primary THA operation irrespective of years in practice after specialty certification as an orthopedic surgeon.
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Affiliation(s)
- Per Jolbäck
- Swedish Hip Arthroplasty Register, Gothenburg,Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg,Department of Orthopaedics, Skaraborgs Hospital, Lidköping, Sweden,Correspondence:
| | - Ola Rolfson
- Swedish Hip Arthroplasty Register, Gothenburg,Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | - Maziar Mohaddes
- Swedish Hip Arthroplasty Register, Gothenburg,Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | | | - Johan Kärrholm
- Swedish Hip Arthroplasty Register, Gothenburg,Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | - Göran Garellick
- Swedish Hip Arthroplasty Register, Gothenburg,Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | - Hans Lindahl
- Swedish Hip Arthroplasty Register, Gothenburg,Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg,Department of Orthopaedics, Skaraborgs Hospital, Lidköping, Sweden
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Wexner T, Rosales-Velderrain A, Wexner SD, Rosenthal RJ. Does implementing a general surgery residency program and resident involvement affect patient outcomes and increase care-associated charges? Am J Surg 2017; 214:147-151. [DOI: 10.1016/j.amjsurg.2016.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 09/25/2016] [Accepted: 11/14/2016] [Indexed: 12/21/2022]
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Wilson MD, Dowsey MM, Spelman T, Choong PFM. Impact of surgical experience on outcomes in total joint arthroplasties. ANZ J Surg 2016; 86:967-972. [PMID: 27598857 DOI: 10.1111/ans.13513] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 12/29/2015] [Accepted: 01/31/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Outcomes of primary total hip and knee arthroplasties performed by consultant surgeons were compared with those performed by orthopaedic trainees. Furthermore, outcomes of these procedures performed by senior trainees were compared with those performed by junior trainees. METHODS Data from the St Vincent's Melbourne Arthroplasty Outcomes Registry and the surgical log kept by trainees were reviewed to investigate if an association exists between surgical experience and clinical outcomes following primary total hip and knee arthroplasties. Multivariate logistic regression analyses were conducted to produce odds ratios with 95% confidence intervals to assess these relationships. RESULTS Arthroplasties performed by trainees were not significantly different from those performed by consultant surgeons in regards to medical, surgical and wound complications. Trainee-performed primary total hip arthroplasties were associated with a 30% increase in the risk of requiring a transfusion compared with consultant cases. Primary total knee arthroplasties performed by junior trainees were associated with a 50% increase in the risk of developing a wound complication compared with those performed by senior trainees. CONCLUSIONS Overall, senior orthopaedic trainees working independently and junior orthopaedic trainees under supervision as the primary surgeon have the ability to achieve a level of clinical outcomes similar to a consultant surgeon. Junior trainees with supervision have the ability to achieve a level of clinical outcomes similar to senior trainees. These findings can be used to further improve orthopaedic training to reduce adverse events during supervised surgery.
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Affiliation(s)
- Mathew D Wilson
- School of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle M Dowsey
- The University of Melbourne Department of Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Orthopaedics, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Tim Spelman
- Department of Orthopaedics, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Peter F M Choong
- The University of Melbourne Department of Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Orthopaedics, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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Snowdon DA, Hau R, Leggat SG, Taylor NF. Does clinical supervision of health professionals improve patient safety? A systematic review and meta-analysis. Int J Qual Health Care 2016; 28:447-55. [DOI: 10.1093/intqhc/mzw059] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2016] [Indexed: 12/20/2022] Open
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