Hospital setting influences surgeon caseloads
By Sally Chapralis
Will orthopaedic surgeons be able to keep pace with the increasing number of total joint revision procedures over the next several decades? According to the researchers for poster exhibit P134, surgeon caseloads are not as much a function of increasing volume of revision surgeries but are more associated with hospital setting, particularly location (rural or urban) and type (teaching or nonteaching).
Recent studies have indicated that the demand for total joint replacement is expected to increase dramatically in the next 25 years. While the number of primary procedures is skyrocketing, revision surgery is also expected to become more prevalent, and will likely double by 2015 for total knee replacement and by 2026 for total hip replacement.
Researchers relied on a Nationwide Inpatient Sample (1990 – 2003) to quantify the arthroplasty procedures and capture the number of surgeons performing primary and revision hip and knee arthroplasties. Using unique, non-identifiable physician identifiers, they were able to catalogue more than 10,000 arthroplasty surgeons per year. Surgeon caseloads were evaluated according to hospital size and type: rural versus urban, teaching versus non-teaching facilities.
The analysis revealed that each surgeon performed an average of 3.3 revision total hip arthroplasties (THA) and 2.9 revision total knee arthroplasties (TKA) per year. The average number of revision THA performed increased at a rate of 0.7 cases per surgeon per decade, while the number of revision TKA increased at a rate of 0.6 cases per surgeon per decade.
This slight increase, however, was disproportionately borne by the most productive 5 percent of revision surgeons. Caseloads were two to five times higher in large urban teaching hospitals than in small rural hospitals. Surgeon caseload differences were also associated with hospital bed size and hospital type.
Researchers noted that surgeons performing the highest number of procedures usually have the lowest complication rates. They conclude that the disparities in revision caseload observed at urban teaching hospitals are consistent with referral from outside institutions.
Researchers include Steven M. Kurtz, PhD; Kevin Ong, PhD; and Edmund Lau, MD, all of Philadelphia; Jordana K. Schmier, MA, of Alexandria, Va., and Fionna Mowat, PhD, of Menlo Park, Cal. The authors report no conflicts of interest.