Influence of Training of Orthopaedic Surgeons on Clinical Outcome after Total Hip Arthroplasty in a High Volume Endoprosthetic Centre

Abstract

Background The study aims to evaluate whether the postoperative outcome and the probability of complications of patients with total hip arthroplasty increases significantly when surgeons in training are in charge, assisted by a high volume surgeon, compared to a highly experienced orthopaedic surgeon, within the context of a high volume hospital certified to EndoCert.

Material and Methods 192 patients with a primary hip arthroplasty were included. To assess the outcome, the Harris Hip Score, WOMAC, SF-36 and EuroQol-5D were surveyed pre- and 12 months postoperatively. As complications we considered the quality indicators defined by EndoCert.

Results We found significant improvements in the postoperative score values with the qualifications of the surgeon in charge, even when a high volume surgeon or a surgeon in training was responsible. If a surgeon in training is assisted by a highly experienced surgeon, the risk of complications does not increase, although the operating time was significantly increased.

Conclusion Both the surgeon in training as well as the arthroplasty patient benefit from implementing the EndoCert system, because the postoperative outcome and the complication probability is independent of the qualifcation of the operating orthopaedic surgeon performing total hip arthroplasty when assisted by an experienced surgeon.

Key words

training - EndoCert - total hip arthroplasty - postoperative outcome - risk of complications

• References/Literatur

• 1 Judge A, Chard J, Learmonth I. et al. The effects of surgical volumes and training centre status on outcomes following total joint replacement: analysis of the Hospital Episode Statistics for England. J Public Health (Oxf) 2006; 28: 116-124
• 2 Katz JN, Losina E, Barrett J. et al. Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States medicare population. J Bone Joint Surg Am 2001; 83-A: 1622-1629
• 3 Palan J, Gulati A, Andrew JG. et al. The trainer, the trainee and the surgeonsʼ assistant: clinical outcomes following total hip replacement. J Bone Joint Surg Br 2009; 91: 928-934
• 4 Gemeinsamer Bundesausschuss. Regelungen des Gemeinsamen Bundesausschusses gemäß § 136b Absatz 1 Satz 1 Nummer 2 SGB V für nach § 108 SGB V zugelassene Krankenhäuser (Mindestmengenregelungen). 15.12.2017 Im Internet: www.g-ba.de/informationen/richtlinien/5/ Stand: 11.04.2018
• 5 Blum K, de Cruppé W, Ohmann C. et al. Mindestmengen bei Knie-TEP-Implantationen. Gesundheitswesen 2008; 70: 209-218
• 6 Zenk K, Bader R, Lenz R. et al. Einfluss der Erfahrung des Operateurs auf die Operationsdauer bei endoprothetischen Eingriffen. OUP 2012; 1: 198-201
• 7 Haas H, Grifka J, Günther KP. et al. Erhebungsbogen für EndoProthetikZentren (EndoCert). 27.02.2018 Im Internet: www.clarcert.com/systeme/endoprothetikzentrum/downloads.html Stand: 11.04.2018
• 8 Haas H, Grifka J, Günther KP. et al. Erhebungsbogen für EndoProthetikZentren der Maximalversorgung (EndoCert). 27.02.2018 Im Internet: www.clarcert.com/systeme/endoprothetikzentrum/downloads.html Stand: 11.04.2018
• 9 Haas H, Grifka J, Günther KP, Heller KD, Niethard F, Windhagen H, Ebner M, Mittelmeier W. Hrsg. EndoCert: Zertifizierung von endoprothetischen Versorgungszentren in Deutschland. Stuttgart: Thieme; 2013
• 10 Bohl DD, Sershon RA, Fillingham YA. et al. Incidence, risk factors, and sources of sepsis following total joint arthroplasty. J Arthroplasty 2016; 31: 2875-2879
• 11 Pugely AJ, Martin CT, Gao Y. et al. The incidence of and risk factors for 30-day surgical site infections following primary and revision total joint arthroplasty. J Arthroplasty 2015; 30 (9 Suppl.): S47-S50
• 12 Koy T, König DP, Eysel P. Einfluss von Mindestmengen auf die Ergebnisqualität in der Hüftendoprothetik. Z Orthop Unfall 2007; 145: 291-296