The volume–outcome relationship for hip fractures: a systematic review and meta-analysis of 2,023,469 patients

Authors

  • Eveline J A Wiegers Department of Public Health, Erasmus University Medical Center, Rotterdam
  • Charlie A Sewalt Department of Public Health, Erasmus University Medical Center, Rotterdam
  • Esmee Venema Department of Public Health, Erasmus University Medical Center, Rotterdam; Department of Neurology, Erasmus University Medical Center, Rotterdam
  • Niels W L Schep Department of Surgery, Maasstad Hospital, Rotterdam
  • Jan A N Verhaar Department of Orthopaedics, Erasmus University Medical Center, Rotterdam
  • Hester F Lingsma Department of Public Health, Erasmus University Medical Center, Rotterdam
  • Dennis Den Hartog Department of Surgery-Traumatology, Erasmus University Medical Center, Rotterdam, The Netherlands

DOI:

https://doi.org/10.1080/17453674.2018.1545383

Abstract

Background and purpose — It has been hypothesized that hospitals and surgeons with high caseloads of hip fracture patients have better outcomes, but empirical studies have reported contradictory results. This systematic review and meta-analysis evaluates the volume–outcome relationship among patients with hip fracture patients.

Methods — A search of different databases was performed up to February 2018. Selection of relevant studies, data extraction, and critical appraisal of the methodological quality was performed by 2 independent reviewers. A random-effects meta-analysis using studies with comparative cut-offs was performed to estimate the effect of hospital and surgeon volume on outcome, defined as in-hospital mortality and postoperative complications.

Results — 24 studies comprising 2,023,469 patients were included. Overall, the quality was reasonable. 11 studies reported better health outcomes in high-volume centers and 2 studies reported better health outcomes in low-volume centers. In the meta-analysis of 11 studies there was a statistically non-significant association between higher hospital volume and both lower in-hospital mortality (adjusted odds ratio (aOR) 0.87, 95% confidence interval (CI) 0.73–1.04) and fewer postoperative complications (aOR 0.87, CI 0.75–
1.02). Four studies on surgeon volume were included in the meta-analysis and showed a minor association between higher surgeon volume and in-hospital mortality (aOR 0.92, CI 0.76–1.12).

Interpretation — This systematic review and metaanalysis did not find an evident effect of hospital or surgeon volume on health outcomes. Future research without volume cut-offs is needed to examine whether a true volume–outcome relationship exists.

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Published

2019-02-04

How to Cite

Wiegers, E. J. A., Sewalt, C. A., Venema, E., Schep, N. W. L., Verhaar, J. A. N. ., Lingsma, H. F., & Den Hartog, D. . (2019). The volume–outcome relationship for hip fractures: a systematic review and meta-analysis of 2,023,469 patients. Acta Orthopaedica, 90(1), 26–32. https://doi.org/10.1080/17453674.2018.1545383