Should high-risk patients seek out care from high-volume surgeons?

Area of Science:

• Orthopedic Surgery
• Arthroplasty Research
• Patient Outcomes

Background:

• Patients with high comorbidity burden (HCB) experience similar quality of life improvements after total hip arthroplasty (THA) but may face higher surgical risks.
• The impact of surgeon volume on THA outcomes for HCB patients remains under-investigated.
• Understanding surgeon volume's role is crucial for optimizing care for complex THA patients.

Purpose of the Study:

• To compare complication rates and implant survivorship in HCB patients undergoing THA by high-volume (HV) versus non-high-volume (non-HV) surgeons.
• To evaluate the influence of surgeon experience on postoperative outcomes in a high-risk THA population.

Main Methods:

• Retrospective review of 1,134 HCB patients (Charlson Comorbidity Index ≥ 5, ASA grade III/IV) undergoing primary elective THA between 2013-2021.
• Patients were stratified into HV (top 25% of surgeons by annual THA volume) and non-HV groups.
• Propensity-matched analysis compared 90-day readmissions, revisions, and implant survivorship using Kaplan-Meier methods.

Main Results:

• High-volume surgeons demonstrated significantly shorter surgical times and lengths of stay compared to non-HV surgeons.
• The HV group experienced significantly fewer 90-day readmissions, all-cause revisions, and septic revisions.
• Kaplan-Meier analysis revealed significantly greater freedom from all-cause and septic revision in the HV group.

Conclusions:

• Total hip arthroplasty patients with a high comorbidity burden treated by high-volume surgeons exhibit reduced 90-day readmissions, fewer revisions, and shorter hospital stays.
• Referral of HCB THA candidates to high-volume surgeons is recommended to mitigate procedural risks and enhance postoperative results.
• Surgeon volume is a significant factor in optimizing outcomes for complex THA cases.