[Patient safety during endoprosthetic training : Does the training of surgeons in primary hip arthroplasty at certified endoprosthesis centres lead to increased complications?]

Background: The aim of the study was to investigate whether the perioperative outcome and the operation-specific process variables in patients with total hip arthroplasty (THA) significantly deteriorate when the operation is performed by an inexperienced surgeon assisted by an experienced one in the context of a certified endoprosthesis center.

Material and methods: 1480 patients who received primary THA for primary coxarthrosis between 2013 and 2016 were included. The relevant data were retrospectively documented from the hospital information system, the discharge letter and the EndoCert form. The surgeons were divided according to their qualifications into experienced (senior surgeon, > 50 THA per year) and inexperienced surgeons (junior surgeon, < 50 THA per year). The collected data and measured variables were then compared based on this subdivision.

Results: Inexperienced surgeons showed a significant increase in the duration of the operation by 20.7 min (senior 62.6 ± 20.4 min; junior 83.3 ± 19.5 min; p ≤ 0.001), as well as the length of hospital stay by 0.25 days (senior 8.8 ± 0.9 days; junior 9.0 ± 0.9 days; p ≤ 0.001). The frequency of transfusions of red cell concentrates was significantly increased with inexperienced surgeons (senior 0.6 ± 1.1 items; junior 0.9 ± 1.4 items; p ≤ 0.001). In contrast, there was no difference in perioperative complications (p = 0.682) or in perioperative blood loss (senior 1.3 ± 0.5 l; junior 1.3 ± 0.5 l; p = 0.097). However, there was a positive correlation between the duration of the operation and blood loss (senior r = 0.183; junior r = 0.214; each p ≤ 0.01).

Conclusion: The training of inexperienced surgeons at a certified endoprosthesis center does not lead to a reduction in patient safety or increased complications when inexperienced surgeons are assisted by experienced surgeons. Due to the extended operating time, however, there is an additional burden on the clinics in competition with non-training clinics, which is not mapped in the DRG system.