Surgeon Volume Impacts Outcomes Following Ankle Fracture Repair

Abstract

Background: The purpose of this study was to determine the impact of surgeon volume on outcomes following ankle fracture fixation. Methods: Over 7 years, 362 patients who met inclusion criteria (>18 years with rotational ankle fractures) were identified and treated by orthopaedic surgeons at several hospitals within an academic medical center and were retrospectively reviewed. Surgeons that completed less than 24 ankle fixations per year (<90th percentile) during the study period were classified as low-volume (LV) and surgeons completing 24 or more ankle fixations per year (>90th percentile) were classified as high-volume (HV). Chart review was conducted to gather data regarding perioperative, radiographic, inpatient, and long-term outcome data (average 12-month follow-up). Results: One hundred thirty-four patients (37.0%) were treated by LV surgeons and 228 (63.0%) were treated by HV surgeons. Although both cohorts had a similar breakdown of fracture patterns ( P = .638), the LV cohort had a greater incidence of open fractures ( P = .024). No differences were found regarding wait time to surgery, surgery duration, and LOS. Radiographically, more patients in the HV cohort achieved anatomic mortise after surgery (96.5% vs 89.6%, P = .008). Patients in the LV cohort took longer to heal radiographically (4.27 ± 2.4 months vs 5.59 ± 2.9 months, P < .001), and also had higher rates of reoperation and hardware removal ( P < .05). Lastly, all cost variables were lower for high-volume surgeons ( P < .05). Conclusion: In this single-center study, we found that patients treated by LV surgeons took 30% longer to heal radiographically and had greater reoperation rates than those treated by HV surgeons. Additionally, patients treated by high-volume surgeons had more anatomic postoperative radiographic ankle mortise reductions and was less cost-effective than when performed by high-volume surgeons. Level of Evidence: Level III, retrospective comparative study.

Healthcare segregation in orthopedic surgery: A statewide analysis of American Indian and Alaska Native patients

“…Brodeur et al 21 found that in a large population of patients who underwent primary total hip arthroplasty, patients who received the intervention from a lower volume surgeon or at a lower volume hospital had higher rates of readmission, in‐hospital mortality, and revision among various other postoperative morbidities. Similar findings have been described for other orthopedic procedures including common spine, ankle, and shoulder surgeries 22–25 . Therefore, the aim of this study is to evaluate the extent of healthcare segregation for AIAN patients receiving common orthopedic arthroplasty and trauma surgeries.…”

“…Similar findings have been described for other orthopedic procedures including common spine, ankle, and shoulder surgeries. [22][23][24][25] Therefore, the aim of this study is to evaluate the extent of healthcare segregation for AIAN patients receiving common orthopedic arthroplasty and trauma surgeries. We hypothesized that AIAN patients would be more likely to receive care from a lower volume surgeon and/or at a lower volume hospital compared to White patients.…”

Bacterial Contamination of Open Fractures: Pathogens and Antibiotic Resistance Patterns in East China

“…The results of all wound cultures were positive in 552 patients (55.9%). The positivity rates were 48.7% and 70.0% for grades II and III open fractures, respectively ( Most pathogens, except Pseudomonas aeruginosa, Enterobacter cloacae, and Acinetobacter baumannii, were sensitive to the prophylactic antibiotics according to the EAST guidelines [5]. We found Gram-negative strains in 83 (30.5%) of grade II open fractures and 84 (30.2%) of grade III open fractures.…”

“…Infections and complications remain major obstacles to the treatment of open fractures of the lower extremities [5][6][7][8]. Our multicenter study was a retrospective study based on six trauma centers in East China, including the Shanghai Jiao Tong University affiliated Sixth People's Hospital (Shanghai, China), the Xiamen University affiliated Fuzhou Second Hospital (Fuzhou, China), the first affiliated hospital of Soochow University (Suzhou, China), the Tongde Hospital of Zhejiang Province (Hangzhou, China), the Second Hospital of Anhui Medical University (Hefei, China), and Shandong Provincial Hospital (Jinan, China).…”