Analysis of the relationship between surgeon procedure volume and complications after total knee arthroplasty using a propensity-matched cohort study

Objectives This study aimed to identify a threshold in annual surgeon volume associated with increased risk of revision (for any cause) and deep infection requiring surgery following primary elective total knee arthroplasty (TKA).Design A propensity score matched cohort study.Setting Ontario, Canada...

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Autores principales:	J Michael Paterson, Tosan Okoro, Sebastian Tomescu, Bheeshma Ravi
Formato:	article
Lenguaje:	EN
Publicado:	BMJ Publishing Group 2021
Materias:	Medical technology R855-855.5 Surgery RD1-811
Acceso en línea:	https://doaj.org/article/7a072a2185a84c91b83251187e508fd5
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spelling	oai:doaj.org-article:7a072a2185a84c91b83251187e508fd52021-11-30T12:00:05ZAnalysis of the relationship between surgeon procedure volume and complications after total knee arthroplasty using a propensity-matched cohort study10.1136/bmjsit-2020-0000722631-4940https://doaj.org/article/7a072a2185a84c91b83251187e508fd52021-11-01T00:00:00Zhttps://sit.bmj.com/content/3/1/e000072.fullhttps://doaj.org/toc/2631-4940Objectives This study aimed to identify a threshold in annual surgeon volume associated with increased risk of revision (for any cause) and deep infection requiring surgery following primary elective total knee arthroplasty (TKA).Design A propensity score matched cohort study.Setting Ontario, Canada.Participants 169 713 persons who received a primary TKA between 2002 and 2016, with 3-year postoperative follow-up.Main outcome measures Revision arthroplasty (for any cause), and the occurrence of deep surgical infection requiring surgery.Results Based on restricted cubic spline analysis, the threshold for increased probability of revision and deep infection requiring surgery was <70 cases/year. After matching of 51 658 TKA recipients from surgeons performing <70 cases/year to TKA recipients from surgeons with greater than 70 cases/year, patients in the former group had a higher rate of revision (for any cause, 2.23% (95% Confidence Interval (CI) 1.39 to 3.07) vs 1.70% (95% CI 0.85 to 2.55); Hazard Ratio (HR) 1.33, 95% CI 1.21 to 1.47, p<0.0001) and deep infection requiring surgery (1.29% (95% CI 0.44 to 2.14) vs 1.09% (95% CI 0.24 to 1.94); HR 1.33, 95% CI 1.17 to 1.51, p<0.0001).Conclusions For primary TKA recipients, cases performed by surgeons who had performed fewer than 70 TKAs in the year prior to the index TKA were at 31% increased relative risk of revision (for any cause), and 18% increased relative risk for deep surgical infection requiring surgery, at 3-year follow-up.J Michael PatersonTosan OkoroSebastian TomescuBheeshma RaviBMJ Publishing GrouparticleMedical technologyR855-855.5SurgeryRD1-811ENBMJ Surgery, Interventions, & Health Technologies, Vol 3, Iss 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medical technology R855-855.5 Surgery RD1-811
spellingShingle	Medical technology R855-855.5 Surgery RD1-811 J Michael Paterson Tosan Okoro Sebastian Tomescu Bheeshma Ravi Analysis of the relationship between surgeon procedure volume and complications after total knee arthroplasty using a propensity-matched cohort study
description	Objectives This study aimed to identify a threshold in annual surgeon volume associated with increased risk of revision (for any cause) and deep infection requiring surgery following primary elective total knee arthroplasty (TKA).Design A propensity score matched cohort study.Setting Ontario, Canada.Participants 169 713 persons who received a primary TKA between 2002 and 2016, with 3-year postoperative follow-up.Main outcome measures Revision arthroplasty (for any cause), and the occurrence of deep surgical infection requiring surgery.Results Based on restricted cubic spline analysis, the threshold for increased probability of revision and deep infection requiring surgery was <70 cases/year. After matching of 51 658 TKA recipients from surgeons performing <70 cases/year to TKA recipients from surgeons with greater than 70 cases/year, patients in the former group had a higher rate of revision (for any cause, 2.23% (95% Confidence Interval (CI) 1.39 to 3.07) vs 1.70% (95% CI 0.85 to 2.55); Hazard Ratio (HR) 1.33, 95% CI 1.21 to 1.47, p<0.0001) and deep infection requiring surgery (1.29% (95% CI 0.44 to 2.14) vs 1.09% (95% CI 0.24 to 1.94); HR 1.33, 95% CI 1.17 to 1.51, p<0.0001).Conclusions For primary TKA recipients, cases performed by surgeons who had performed fewer than 70 TKAs in the year prior to the index TKA were at 31% increased relative risk of revision (for any cause), and 18% increased relative risk for deep surgical infection requiring surgery, at 3-year follow-up.
format	article
author	J Michael Paterson Tosan Okoro Sebastian Tomescu Bheeshma Ravi
author_facet	J Michael Paterson Tosan Okoro Sebastian Tomescu Bheeshma Ravi
author_sort	J Michael Paterson
title	Analysis of the relationship between surgeon procedure volume and complications after total knee arthroplasty using a propensity-matched cohort study
title_short	Analysis of the relationship between surgeon procedure volume and complications after total knee arthroplasty using a propensity-matched cohort study
title_full	Analysis of the relationship between surgeon procedure volume and complications after total knee arthroplasty using a propensity-matched cohort study
title_fullStr	Analysis of the relationship between surgeon procedure volume and complications after total knee arthroplasty using a propensity-matched cohort study
title_full_unstemmed	Analysis of the relationship between surgeon procedure volume and complications after total knee arthroplasty using a propensity-matched cohort study
title_sort	analysis of the relationship between surgeon procedure volume and complications after total knee arthroplasty using a propensity-matched cohort study
publisher	BMJ Publishing Group
publishDate	2021
url	https://doaj.org/article/7a072a2185a84c91b83251187e508fd5
work_keys_str_mv	AT jmichaelpaterson analysisoftherelationshipbetweensurgeonprocedurevolumeandcomplicationsaftertotalkneearthroplastyusingapropensitymatchedcohortstudy AT tosanokoro analysisoftherelationshipbetweensurgeonprocedurevolumeandcomplicationsaftertotalkneearthroplastyusingapropensitymatchedcohortstudy AT sebastiantomescu analysisoftherelationshipbetweensurgeonprocedurevolumeandcomplicationsaftertotalkneearthroplastyusingapropensitymatchedcohortstudy AT bheeshmaravi analysisoftherelationshipbetweensurgeonprocedurevolumeandcomplicationsaftertotalkneearthroplastyusingapropensitymatchedcohortstudy
_version_	1718406629908545536

Analysis of the relationship between surgeon procedure volume and complications after total knee arthroplasty using a propensity-matched cohort study

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