Surgeons who do more total hip replacements have fewer complications
It makes sense that surgeons who do more total hip procedures have fewer complications than surgeons who only do this surgery occasionally. The whole team improves when a procedure is repeated over and over again. This includes the nurses before and after surgery because they take care of more patients who have had a total hip procedure. Even the anesthesia team, x-ray technicians and everyone else improves when they provide care for more people who have total hip replacements.
While everyone agrees that doing more total hips decreases risks and complications, the number needed to achieve the best results isn’t known. In other words, does a surgeon doing two cases a month have the same low complication rate as a surgeon doing ten cases each month? High-volume surgeons have fewer complications but what is the number that allows surgeons to be as good as they can get? After achieving that level of excellence, more cases may improve efficiency, but more cases don’t mean better results or fewer complications for patients. Several scientific studies have tried to determine the threshold that surgeons should achieve to have more successful results compared to surgeons who do fewer procedures. Once that threshold has been achieved, there is little gain in doing more because the surgeon and his/her team are experienced enough to know what they are doing.
A recent study from Canada was published in the British Medical Journal (Ravi B, BMJ. 2014 May 23;348) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4032026/pdf/bmj.g3284.pdf. This study suggested that surgeons who perform more than 35 total hips each year have the lowest complication rates compared to surgeons who do fewer total hip replacement procedures. This is consistent with an earlier study in the United States that showed fewer complication rates for surgeons doing more than 50 cases each year compared to surgeons doing less than 25 cases each year. While the “high-volume” surgeons had better results than the “low-volume” surgeons, there is a middle group that does more than 25 cases each year but fewer than 35 to 50 cases. The differences were less clear between these “medium-volume” surgeons and the “high-volume” surgeons.
The take-home message may be that surgeons doing fewer than two total hips each month may not achieve good results as often as surgeons doing more than that, but surgeons doing more than 3 to 4 total hips per month seem to achieve the best results possible.
