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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2012

Open Access 01-12-2012 | Research article

The role of surgeon volume on patient outcome in total knee arthroplasty: a systematic review of the literature

Authors: Rick L Lau, Anthony V Perruccio, Rajiv Gandhi, Nizar N Mahomed

Published in: BMC Musculoskeletal Disorders | Issue 1/2012

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Abstract

Background

A number of factors have been identified as influencing total knee arthroplasty outcomes, including patient factors such as gender and medical comorbidity, technical factors such as alignment of the prosthesis, and provider factors such as hospital and surgeon procedure volumes. Recently, strategies aimed at optimizing provider factors have been proposed, including regionalization of total joint arthroplasty to higher volume centers, and adoption of volume standards. To contribute to the discussions concerning the optimization of provider factors and proposals to regionalize total knee arthroplasty practices, we undertook a systematic review to investigate the association between surgeon volume and primary total knee arthroplasty outcomes.

Methods

We performed a systematic review examining the association between surgeon volume and primary knee arthroplasty outcomes. To be included in the review, the study population had to include patients undergoing primary total knee arthroplasty. Studies had to report on the association between surgeon volume and primary total knee arthroplasty outcomes, including perioperative mortality and morbidity, patient-reported outcomes, or total knee arthroplasty implant survivorship. There were no restrictions placed on study design or language.

Results

Studies were variable in defining surgeon volume (‘low’: <3 to <52 total knee arthroplasty per year; ‘high’: >5 to >70 total knee arthroplasty per year). Mortality rate, survivorship and thromboembolic events were not found to be associated with surgeon volume. We found a significant association between low surgeon volume and higher rate of infection (0.26% - 2.8% higher), procedure time (165 min versus 135 min), longer length of stay (0.4 - 2.13 days longer), transfusion rate (13% versus 4%), and worse patient reported outcomes.

Conclusions

Findings suggest a trend towards better outcomes for higher volume surgeons, but results must be interpreted with caution.
Appendix
Available only for authorised users
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Metadata
Title
The role of surgeon volume on patient outcome in total knee arthroplasty: a systematic review of the literature
Authors
Rick L Lau
Anthony V Perruccio
Rajiv Gandhi
Nizar N Mahomed
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2012
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-13-250

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