Orthopaedic procedure volume and patient outcomes: a systematic literature review

The association between greater hospital procedure volumes and improved patient outcomes has been well established with respect to a variety of procedures and treatments. However, this association in orthopaedics has not been summarized systematically. We reviewed existing literature on associations between hospital and surgeon procedure volume and patient outcomes in orthopaedic surgery. The patient outcomes examined were mortality, hip dislocation, infection, revision, complications, functional outcome, and satisfaction. Of the 26 articles reviewed, most examined outcomes after primary joint arthroplasties (predominantly hip arthroplasties) with a relatively limited number of studies examining revision arthroplasties, hip fractures, spine, or general orthopaedics. No studies evaluated any other subspecialties. We found an association between higher hospital volumes and lower rates of mortality and hip dislocation. We also found an association between higher surgeon volume and lower rates of hip dislocation. All other associations were negative or inconclusive. In addition, surgeon volume had a greater effect on patients than hospital volume for primary and revision joint arthroplasties, whereas hospital volume was more strongly related to outcome than surgeon volume for the other procedures examined. Our findings suggest the need for additional studies in the various subspecialties to establish more definitive conclusions.