Volume-outcome relationship in revision hip replacement - Results from a low volume hospital
Fahim Anwar1, Kalpesh Shah2, Ian McLean3
1Spinal Injuries Unit, Institute of Neurological Sciences, Southern General Hospital, Glasgow G51 4TF, United Kingdom.
Introduction:
Mortality and morbidity are both increased during revision hip surgery. Higher hospital procedure volumes have been associated with lower rates of mortality and/or complications according to some reports - the "practice makes perfect" hypothesis.
Aim:
The aim of the study was to test "practice makes perfect; hypothesis with regards to revision hip surgery at our low volume hospital.
Methods:
This is a retrospective study of all the patients who underwent revision hip arthroplasty under the care of the senior author between February 2002 and January 2006. Data was collected about the 30-day and one-year mortality, post-operative complications like deep vein thrombosis (DVT), pulmonary embolism (PE), superficial or deep wound infections, dislocations, and the Oxford hip score.
Results:
The rate of revision hip surgery carried out in our hospital was 6.25 per year. There was no 30-day mortality, stroke within 3 months, dislocations within one year, re-admission within one month, one-year mortality and deep infections within one year. The final outcome after revision hip surgery, based on Oxford questionnaire, showed that 72% had an excellent outcome and 8% had poor outcome.
Conclusion:
Volume and outcome relationship may not contribute towards the final outcome when individual surgeons and hospitals are considered. Good general hospital care can greatly affect the health outcome for a particular procedure. Strategies aimed at improving the general hospital care may benefit the patients as much as volume based regionalization.
