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Surgeon Volume and Experience Both Independently Drive Value in Primary Total Joint Arthroplasty: Findings From a
Nicholas Sauder1, Shian L Peterson2, Aman Sharma2
1Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts.
Background:
Surgeon and surgeon experience may influence clinical outcomes in both total knee arthroplasty (TKA) and total hip arthroplasty (THA). Clinical outcomes can be integrated with costs to calculate value. We aimed to determine if surgeon experience and volume were associated with increased value in arthroplasty.
Methods:
We retrospectively sourced 2,786 primary TKAs and 2,203 primary THAs from a prospectively maintained multi-institutional database. A total of 37 surgeons performed the procedures. Knee Injury and Hip Disability Osteoarthritis Outcome Score-Physical Function Short Forms (HOOS-PS) were collected. Costs of care were determined using Time-Driven Activity-Based Costing and converted from US dollars to arbitrary cost units (CUs). Value was calculated as the quotient of the 1-year change in HOOS-PS or Knee Injury Osteoarthritis Outcome Score-Physical Function Short Forms and the costs of care. We determined if surgeon volume and experience correlated with value after adjusting for confounders. Stratum-specific likelihood ratio analysis determined meaningful thresholds in any associations.
Results:
In THA, increased Value HOOS-PS was independently associated with both surgeon annual THA volume (P = 0.001) and surgeon years of experience (P < 0.001). The stratum-specific likelihood ratio analysis revealed thresholds in volume (≥ 61 annual THAs) and experience (≥ three years) associated with increased Value HOOS-PS. High-volume THA surgeons had reduced costs of care (1,055 CUs versus 1,263 CUs; P < 0.001) but similar delta HOOS-PS (+25.2 versus +23.6; P = 0.171). High-experience THA surgeons had not only reduced costs of care (1,074 CUs versus 1,213 CUs; P < 0.001) but also marginally increased delta HOOS-PS (+25.3 versus +20.9; P = 0.003). Similar findings were observed in TKA.
Conclusions:
Surgeon volume and experience both independently drive value in arthroplasty. High-volume and high-experience arthroplasty surgeons streamline costs of care through shorter lengths of stay, faster operative times, and increased home discharges. As surgeons progress in their careers-gaining experience and increasing their annual case volume-they may improve in their ability to deliver cost-effective arthroplasty care.
