Evaluation of surgeon demographics and association with postoperative complication rates after total hip arthroplasty at the United States News and World Report top-ranked orthopaedic hospitals

Introduction

The rankings provided by the U.S. News & World Report (USNWR) are widely consulted to identify leading hospitals. This study aimed to (1) investigate the demographic characteristics of surgeons practicing at USNWR Top-Ranked Orthopaedic hospitals and (2) evaluate if any were associated with complication rates following total hip arthroplasty (THA).

Methods

The 2009 to 2013 USNWR ‘Orthopaedic’ hospital rankings were curated. Surgeons performing THA and their adjusted postoperative complication rates were compiled using publicly available data from the Centers for Medicare and Medicaid Services (2009 to 2013). Demographic information for each surgeon, including fellowship training, years of practice, age, sex, practice setting, medical degree, residency reputation, case volume, and geographic region, was collected using an internet search algorithm. Logistic regression analyses were conducted to evaluate the association between surgeon demographics and complication rates, with a significance level set at P < 0.008.

Results

Between 2009 and 2013, a total of 659 orthopaedic surgeons conducted THA procedures at 80 USNWR-top-ranked hospitals. The average case volume for THA was 171 (range: 20 to 1,122), and the average age of surgeons was 50.7 years (range: 32 to 75). A majority of surgeons (56.4%) had completed an orthopaedic surgery fellowship. The mean adjusted 30-day complication rate was 2.2% (range: 1.1 to 4.4%). Surgeon age ≤ 42 years (odds ratio (OR) 3.1; P = 0.006) and lower case volumes (≤ 100 cases) (OR 2.5; P < 0.0001) were associated with higher complication rates. However, sex, geographic region, completion of fellowship, medical degree type, and residency reputation did not show significant associations.

Discussion

Surgeon-related factors may be associated with complication rates following THA conducted at USNWR Top-Ranked Orthopaedic Hospitals, which could be informative for patients and hospitals assessing quality of care.

Level of evidence

IV.