The impact of surgeon volume and hospital volume on postoperative mortality and morbidity after hip fractures: A systematic review

Abstract

Introduction: Recently, strategies aimed at optimizing provider factors have been proposed, including regionalization of surgeries to higher volume centers, and adoption of volume standards. With limited literature investigating the impact of hospital and surgeon volume on the outcome of hip fracture repairs, we undertook a systematic review to solidify the findings and attempt to arrive at a definitive conclusion with respect to both factors.

Materials and methods: We performed a systematic review examining the association between surgeon and hospital volume and hip fracture outcomes. To be included in the review, the study population had to include patients undergoing any hip fracture repair such as hemiarthroplasty (HA), internal fixation (ORIF) and total hip arthroplasty (THA). A total of five studies investigating surgeon volume and twelve studies investigating hospital volume were included in the study. With the exception of one study investigating both surgeon and hospital volume, volume thresholds were defined for all studies.

Results: Studies were variable in defining surgeon and hospital volume thresholds. Low surgeon volume was associated with a longer LOS and a higher risk of mortality, but results were contrasting with respect to postoperative complications. High volume hospitals fared better than low volume with respect to length of stay, postoperative complications and time to surgery.

Conclusions: Increasing hospital volume was a more stronger predictor of postoperative outcomes as compared to surgeon volume. However, there are still few researches with respect to surgeon volume and further studies may yield a more definitive answer to this question.

Keywords: Hip; Hip fractures; Hospital volume; Provider volume; Surgeon volume.