Richard J Holleyman, Simon S Jameson, R M Dominic Meek, Vikas Khanduja, Mike R Reed, Andrew Judge, Tim N Board
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Multivariable Cox proportional hazard models with restricted cubic splines were used to define associations between volume and outcome.</p><p><strong>Results: </strong>Among 12,961 RHAs there were 513 re-revisions within two years, and 95 deaths within 90 days of surgery. The risk of re-revision was highest for a consultant's first RHA (hazard ratio (HR) 1.56 (95% CI 1.15 to 2.12)) and remained significantly elevated for their first 24 cases (HR 1.26 (95% CI 1.00 to 1.58)). Annual consultant volumes of five/year were associated with an almost 30% greater risk of re-revision (HR 1.28 (95% CI 1.00 to 1.64)) and 80% greater risk of 90-day mortality (HR 1.81 (95% CI 1.02 to 3.21)) compared to volumes of 20/year. RHAs performed at hospitals which had cumulatively undertaken fewer than 167 RHAs were at up to 70% greater risk of re-revision (HR 1.70 (95% CI 1.12 to 2.59)), and those having undertaken fewer than 307 RHAs were at up to three times greater risk of 90-day mortality (HR 3.05 (95% CI 1.19 to 7.82)).</p><p><strong>Conclusion: </strong>This study found a significantly higher risk of re-revision and early postoperative mortality following first-time single-stage RHA for aseptic loosening when performed by lower-volume consultants and at lower-volume institutions, supporting the move towards the centralization of such cases towards higher-volume units and surgeons.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 10","pages":"1050-1058"},"PeriodicalIF":4.9000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association between surgeon and hospital volume and outcome of first-time revision hip arthroplasty for aseptic loosening.\",\"authors\":\"Richard J Holleyman, Simon S Jameson, R M Dominic Meek, Vikas Khanduja, Mike R Reed, Andrew Judge, Tim N Board\",\"doi\":\"10.1302/0301-620X.106B10.BJJ-2024-0347.R1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>This study evaluates the association between consultant and hospital volume and the risk of re-revision and 90-day mortality following first-time revision of primary hip arthroplasty for aseptic loosening.</p><p><strong>Methods: </strong>We conducted a cohort study of first-time, single-stage revision hip arthroplasties (RHAs) performed for aseptic loosening and recorded in the National Joint Registry (NJR) data for England, Wales, Northern Ireland, and the Isle of Man between 2003 and 2019. 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引用次数: 0
摘要
目的：本研究评估了顾问和医院数量与因无菌性松动首次翻修初次髋关节置换术后再次翻修风险和 90 天死亡率之间的关系：我们对2003年至2019年期间英格兰、威尔士、北爱尔兰和马恩岛因无菌性松动而进行的首次单期翻修髋关节置换术（RHA）进行了一项队列研究。患者标识符用于将记录与国家死亡率数据联系起来，并与国家关节登记数据联系起来，以确定后续的再翻修手术。使用限制性立方样条的多变量 Cox 比例危险模型来确定容量与结果之间的关系：结果：在 12961 例 RHA 中，有 513 例在两年内再次手术，95 例在手术后 90 天内死亡。顾问首次实施 RHA 的再次手术风险最高（危险比 (HR) 1.56 (95% CI 1.15 to 2.12)），而在前 24 个病例中，再次手术的风险仍然显著升高（HR 1.26 (95% CI 1.00 to 1.58)）。与年咨询量为 20 例的患者相比，年咨询量为 5 例的患者再次手术的风险高出近 30% （HR 1.28 (95% CI 1.00 to 1.64)），90 天死亡率风险高出 80% （HR 1.81 (95% CI 1.02 to 3.21)）。在累计实施RHA少于167例的医院实施RHA，再次手术的风险要高出70%（HR 1.70 (95% CI 1.12 to 2.59)），而实施RHA少于307例的医院90天死亡风险要高出3倍（HR 3.05 (95% CI 1.19 to 7.82)）：本研究发现，由工作量较少的顾问和在工作量较少的机构进行首次无菌性松动单级RHA手术后，再次复诊和术后早期死亡的风险明显较高，这支持了将此类病例集中到工作量较高的单位和外科医生的做法。
Association between surgeon and hospital volume and outcome of first-time revision hip arthroplasty for aseptic loosening.
Aims: This study evaluates the association between consultant and hospital volume and the risk of re-revision and 90-day mortality following first-time revision of primary hip arthroplasty for aseptic loosening.
Methods: We conducted a cohort study of first-time, single-stage revision hip arthroplasties (RHAs) performed for aseptic loosening and recorded in the National Joint Registry (NJR) data for England, Wales, Northern Ireland, and the Isle of Man between 2003 and 2019. Patient identifiers were used to link records to national mortality data, and to NJR data to identify subsequent re-revision procedures. Multivariable Cox proportional hazard models with restricted cubic splines were used to define associations between volume and outcome.
Results: Among 12,961 RHAs there were 513 re-revisions within two years, and 95 deaths within 90 days of surgery. The risk of re-revision was highest for a consultant's first RHA (hazard ratio (HR) 1.56 (95% CI 1.15 to 2.12)) and remained significantly elevated for their first 24 cases (HR 1.26 (95% CI 1.00 to 1.58)). Annual consultant volumes of five/year were associated with an almost 30% greater risk of re-revision (HR 1.28 (95% CI 1.00 to 1.64)) and 80% greater risk of 90-day mortality (HR 1.81 (95% CI 1.02 to 3.21)) compared to volumes of 20/year. RHAs performed at hospitals which had cumulatively undertaken fewer than 167 RHAs were at up to 70% greater risk of re-revision (HR 1.70 (95% CI 1.12 to 2.59)), and those having undertaken fewer than 307 RHAs were at up to three times greater risk of 90-day mortality (HR 3.05 (95% CI 1.19 to 7.82)).
Conclusion: This study found a significantly higher risk of re-revision and early postoperative mortality following first-time single-stage RHA for aseptic loosening when performed by lower-volume consultants and at lower-volume institutions, supporting the move towards the centralization of such cases towards higher-volume units and surgeons.
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