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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).
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BMC Musculoskeletal Disorders

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