Association between surgeon experience, level of supervision, and outcomes after hip fracture.

IF 3.3 Q1 ORTHOPEDICS

Bone & Joint Open Pub Date : 2026-06-04 DOI:10.1302/2633-1462.76.BJO-2025-0321.R1

En Lin Goh, May Ee Png, David Metcalfe, Juul Achten, Duncan Appelbe, Xavier L Griffin, Jonathan A Cook, Matthew L Costa, En Lin Goh, May Ee Png, David Metcalfe, Juul Achten, Duncan Appelbe, Xavier L Griffin, Jonathan A Cook, Matthew L Costa, Michael Barrett, Peter Hull, David Melling, Jonathan Kosy, Charalambous P Charalambous, Oliver Keast-Butler, Paul Magill, Rathan Yarlagadda, Girish Vashista, Terence Savaridas, Seb Sturridge, Graham Smith, Kishore Dasari, Deepu Bhaskar, Stefan Bajada, Ewan Bigsby, Ansar Mahmood, Mark Dunbar, Andrea Jimenez, Ryan Wood, James Penny, William Eardley, Robert Handley, Suresh Srinivasan, Matt Gee, Ashwin Kulkarni, John Davison, Mohammad Maqsood, Amit Sharma, Chris Peach, Ahsan Sheeraz, Piers Page, Andrew Kelly, Iain McNamara, Lee Longstaff, Mike Reed, Iain Moppett, Ayman Sorial, Theophilus Joachim, Aaron Ng, Kieran Gallagher, Mark Farrar, Ad Ghande, Jonathan Bird, Shyam Rajagopalan, Andrew McAndrew, Andrew Sloan, Rory Middleton, Ian Dos Remedios, Damian McClelland, Benedict Rogers, James Berstock, Sharad Bhatnagar, Owen Diamond, Paul Fearon, Inder Gill, Doug Dunlop, Tim Chesser, Mehool Acharya, Deepak Sree, Johnathan Craik, David Hutchinson, David Johnson, Mosab Elgalli, Paul Dixon, Pregash Ellapparadja, Guy Slater, Jakub Kozdryk, Jonathan Young, Khitish Mohanty Ben Ollivere, Mohammad Faisal, Callum Clark, Baljinder Dhinsa, Ibrahim Malek, Sam Heaton, Oliver Blocker, Kanthan Theivendran

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引用次数: 0

Abstract

Aims: Patients with a hip fracture are treated by surgeons at various stages of training, under different levels of supervision. However, it is unclear whether their experience and the level of supervision are associated with patient outcomes. The aim of this study was to investigate the relationship between operating surgeon experience and level of supervision, and the patients' subsequent quality of life (QoL), mortality, and complications after surgery for a hip fracture.

Methods: A multicentre, prospective cohort study of patients aged 60 years and older with a hip fracture in the UK. Primary exposure was operating surgeon grade and level of supervision. Outcomes were health-related quality of life (HRQoL; EuroQol five-dimension five-level questionnaire (EQ-5D-5L)), mortality, and complications at four months. Linear and Cox proportional hazards regression models were fitted to assess the relationship between operating surgeon grade and level of supervision, and HRQoL, mortality, and complications.

Results: Among 24,523 patients with a hip fracture, there were 12,702 consultant-performed and 11,365 resident-performed operations. Operations performed by supervised residents had better recovery of EQ-5D-5L (mean difference (MD) 0.02, 95% CI 0.01 to 0.03; p < 0.001), a similar risk of mortality (HR 0.92, 95% CI 0.84 to 1.01; p = 0.083), but higher risks of reoperation (HR 1.29, 95% CI 1.06 to 1.57; p = 0.009), blood transfusion (HR 1.44, 95% CI 1.28 to 1.62; p < 0.001), acute kidney injury (HR 1.72, 95% CI 1.46 to 2.04; p < 0.001), lower respiratory tract infection (HR 1.22, 95% CI 1.10 to 1.35; p < 0.001), cerebrovascular accident (HR 1.98, 95% CI 1.33 to 2.95, p < 0.001), and myocardial infarction (HR 1.91, 95% CI 1.33 to 2.74; p < 0.001), compared with operations performed by consultants. Operations performed by unsupervised residents had better recovery of EQ-5D-5L (MD 0.02, 95% CI 0.00 to 0.03; p = 0.008), a similar risk of mortality (HR 0.92, 95% CI 0.81 to 1.06; p = 0.260), but a higher risk of blood transfusion (HR 1.54, 95% CI 1.33 to 1.80; p < 0.001) compared with operations performed by consultants.

Conclusion: Operations performed by residents were associated with a better recovery of QoL, similar mortality, but slightly more complications compared with consultants. This highlights the need for tailored supervision and structured training to optimize outcomes and ensure patient safety.

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外科医生经验、监督水平与髋部骨折后预后之间的关系。

目的：髋部骨折患者在不同的训练阶段，在不同的监督下，由外科医生治疗。然而，目前尚不清楚他们的经验和监督水平是否与患者的预后有关。本研究的目的是探讨手术外科医生的经验和监督水平与髋部骨折术后患者的生活质量、死亡率和并发症之间的关系。方法：对英国60岁及以上髋部骨折患者进行多中心前瞻性队列研究。主要暴露是外科医生的等级和监督水平。结果是健康相关生活质量（HRQoL； EuroQol五维度五水平问卷（EQ-5D-5L））、死亡率和4个月时的并发症。拟合线性和Cox比例风险回归模型，评估手术医师等级和监督水平与HRQoL、死亡率和并发症之间的关系。结果：在24,523例髋部骨折患者中，有12,702例由顾问进行手术，11,365例由住院医师进行手术。有监护的住院医师进行手术后EQ-5D-5L恢复较好(平均差（MD） 0.02, 95% CI 0.01 ~ 0.03；p < 0.001),类似的死亡率的风险(HR 0.92, 95%可信区间0.84到1.01;p = 0.083),但高再次手术的风险(HR 1.29, 95%可信区间1.06到1.57;p = 0.009),输血(HR 1.44, 95%可信区间1.28到1.62;p < 0.001),急性肾损伤(HR 1.72, 95%可信区间1.46到2.04;p < 0.001),下呼吸道感染(HR 1.22, 95%可信区间1.10到1.35;p < 0.001),脑血管意外(HR 1.98, 95%可信区间1.33到2.95,p < 0.001),心肌梗死(HR 1.91, 95%可信区间1.33到2.74;P < 0.001)，与顾问进行的手术相比。无监护住院医师进行的手术有更好的EQ-5D-5L恢复（MD 0.02, 95% CI 0.00 ~ 0.03; p = 0.008），死亡率相似（HR 0.92, 95% CI 0.81 ~ 1.06; p = 0.260），但输血风险较高（HR 1.54, 95% CI 1.33 ~ 1.80; p < 0.001）。结论：住院医师手术患者的生活质量恢复较住院医师好，死亡率相近，但并发症略多于住院医师。这突出了需要量身定制的监督和结构化培训，以优化结果并确保患者安全。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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