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Table 2 Surgeon volume thresholds and outcomes of the studies

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

Study Surgeon volume thresholds Outcomes Result LV vs. HV surgeons Adjusted odds ratios* (95% CI)
  Low Medium High V. High     
Kreder et al (2003) <14 14-42 >42 -- LOS p < 0.05 11.5 vs 10.0 days NR
      MR (in-hospital) NS 0.5% vs 0.3% NR
      MR (90 day) NS 0.8% vs 0.4% 1.76 (0.8-3.8) (LV:HV)
      Infection (3 yr) NS 2.1% vs 2.3% 0.88 (0.5-1.3)(LV:HV)
      Revision (3 yr) NS 2.2% vs 1.9% 1.00 (0.6-1.7)(LV:HV)
      Medical complication NS 9% vs 11% 0.98 (0.7-1.3)(LV:HV)
Katz et al (2004) 1-12 13-25 26-50 >50 Pneumonia p < 0.01# 1.68% vs 1.02% 0.72 (0.54-0.95) (HV:LV)#
      Infection p < 0.01# 0.55% vs 0.29% 0.62 (0.37-1.06) (HV:LV)#
      MI NS 0.8% vs 0.69% 0.90 (0.64-1.28)(HV:LV)
      PE NS 0.76% vs 0.74% 1.06 (0.73-1.54)(HV:LV)
      MR (90d) NS 0.67% vs 0.58% 0.97 (0.66-1.43)(HV:LV)
Katz et al (2007) 1-6   > 6   poor WOMAC score (score < 60) p < 0.05 22.6% vs 8.4% 2.1 (1.1-4.2) (LV:HV)
      flex to 90 degrees p < 0.05 NR 2.9 (1.6-5.5) (LV:HV)
      full extension p < 0.05 NR 2.2 (1.1-4.4) (LV:HV)
      Dissatisfied with TKA NS NR 1.4 (0.6-3.3)(LV:HV)
Muilwijk et al (2007) 5 -- 12 -- Infection p < 0.05 4.9% vs 2.1% 0.43 (0.23-0.80) (HV:LV)
Manley et al (2009) 1-12 13-25 26-50 >50 Early - mid term survivoship (8 years) NS NR 0.94 (0.78-1.15)(LV:HV)
Ong et al (2009) 1-12 13-25 26-50 >50 Procedure duration p < 0.05 165 mins vs 135 mins NR
Yasunaga et al (2009) Used surgeon career volume of TKR as surgeon volume variable: <100, 100-499, >499 Medical complication NS 7.7% vs 13.5% 1.17 (0.66-2.07) (HV:LV)
   LOS NS 38.9 vs 35 days NR    
Paterson et al (2010) 2-35 36-50 51-70 >70 LOS p < 0.05 NR NR
      MR NS 0.624% vs 0.547% 1.02 (0.63-1.67)(HV:LV)
      Readmission for surgery (1 yr) NS 0.594% vs 0.403% 0.81 (0.41-1.62)(HV:LV)
      Revision (1 yr) NS 1.279% vs 0.922% 0.75 (0.51-1.09)(HV:LV)
      Medical Complication NS 4.217% vs 4.553% 0.90 (0.67-1.19)(HV:LV)
Wei et al (2010) 1-3 4-9 10-463 -- LOS p < 0.05 10.79 vs 8.66 days NR
      Infection p < 0.05 0.99% vs 0.54% 2.31 (1.379-3.876) (LV:HV)
Styron et al (2011) 1-17 18-35 36-66 >67 LOS p < 0.05 4.14 vs 3.74 days NR
Baker et al (2011) 1-52   >52   Transfusion rate p < 0.05 13% vs 4% NR
  1. (LV Low volume, HV High or v. high volume, MR Mortality rate, LOS Length of stay, NS Not significant, NR Raw proportions not reported, PE Pulmonary embolus, DVT Deep venous thrombosis, MI Myocardial infarction, mins Time in minutes, WOMAC Western Ontario and McMaster Universities Osteoarthritis Index, * - see Table3 for covariates adjusted for in adjusted odds ratios, # - significant for trend, 95% CI = 95% confidence intervals, HV:LV = odds ratio expressed as high volume to low volume, LV:HV Odds ratio expressed as low volume to high volume, TKA Total knee arthroplasty).