Table 2.
from retrospective database analyses (joints and carpal tunnel)
| Degen et al. [10] (2017) | Evers et al. [11] (2018) | Jain et al. [12] (2005) | Jain et al. [13] (2004) | Liu et al. [14] (2018) | |
|---|---|---|---|---|---|
| Country | USA | The Netherlands | USA | USA | USA |
| Sponsor | National Institute of Health/ National Institute for Arthritis and Musculoskeletal and Skin Diseases (R01AR066069) | National Institute of Health/ National Institute of Arthritis and Musculoskeletal and Skin Diseases (RO1 AR82813) | NA | NA | NA |
| COI |
1 author (B.T.K) has COI due to fees form Arthrex and A-3 surgical |
None | NA | NA | None |
| Study design | Retrospective database analysis of 137 surgical centres (multivariate regression) | Retrospective database analysis of 11 surgical centres (univariate and multivariate regression) | Retrospective database analysis of unclear number of surgical centres (univariate and multivariate regression) | Retrospective database analysis of unclear number of surgical centres (multivariate logistic and linear regression) | Retrospective database analysis of unclear number of surgical centres (multivariate regression) |
| Conducted in | 1998–2012 | 2011–2015 | 1997–2000 | 1997–2000 | 2009–2013 |
| Indication | Hip arthroscopy | Carpal tunnel syndrome | See inclusion criteria below | See inclusion criteria below | Anterior cruciate ligament injury |
| Intervention | Primary hip arthroscopy | Open carpal tunnel releases | Rotator cuff repair | ACL reconstruction & Meniscectomy | ACL reconstruction |
| Setting | Outpatient | Outpatient | Outpatient | Outpatient | Outpatient |
| Type of volume analysis (surgeon/hospital) | Surgeon | Surgeon | Surgeon & hospital | Surgeon & hospital | Hospital |
| Comparator | NA | NA | NA | NA | NA |
| Number of pts | 7836 | 2057a | 10,934b |
ACL: 32,440 Men: 195,597c |
26,873 |
| Number of procedures | 8267d | 2057 | NA | NA | NA |
| Number of surgeons | 295 | 17 | NA | NA | NA |
| Number of hospitals | 137 | 11 | NA | NA | NA |
| Surgeon volume categories, n (cases/year) | ACL/Men: | ||||
| β Low | < 102 | 6–44 | < 15e | < 25f/< 75 | NA |
| β Medium | 102 ≤ x < 164 | 47–71 | 15 ≤ x < 30 | 25 ≤ x < 75/75 ≤ x < 175 | |
| β High | 164 ≤ x < 340 | 75–163 | ≥30 | ≥75/≥175 | |
| β Very high | ≥340 | NA | NA | NA | |
| Hospital volume categories, n (cases/year) | ACL/Men: | ||||
| β Low | NA | NA | < 75 | < 125/< 600g | < 1006 |
| β Medium | NA | NA | ≥75- < 200 | 125 ≤ x < 300/600 ≤ x < 1200 | ≥100- < 500 |
| β High | NA | NA | ≥200 | ≥300/≥1200 | ≥500 |
| Operating time, median in min (range) | NA | NA | 102 (30–595)h |
ACL: 125 (NA) Men: 55 (NA) |
NA |
| Inclusion criteria | HA for diagnosis with or without synoval biopsy, HA for removal of loose/foreign body, HR & chondroplasty, abrasion arthroplasty & resection of labrum, HA & synovectomy, HA with femoroplasty, HA with acetabuloplasty, HA with labral repair, total hip replacement, resurfacing hip & partial/total acetabulum & femoral head | Consent, primary carpal tunnel release, baseline and follow-up measurement of BCTQ | Rupture of the rotator cuff, disorders of bursae and tendon, sprains and strains of the rotator cuff capsule |
ACL: Complete rupture of old disruption of ACL and sprain of cruciate ligament of the knee Men: derangement, bucket handle tear, simple tear of the meniscus or cartilage |
NA |
| Exclusion criteria | NA | Unavailable operative report, unidentified surgeon, cases in which surgeons did not perform CTRs for at least 1 year within the cohort | Shoulder bone infection, present surgery as corrective surgery, malignancy, pathologic fracture, fracture due to injury in the bones of the shoulder region, or simultaneous total or partial shoulder arthroplasty | ACL/Men: Lower leg bone infections like osteomyelitis, inflammatory reaction due to graft, correction surgery, malignancies or pathological fractures, fractures due to injury, simultaneous knee arthroplasty, rheumatoid arthritis, operating time < 45 min & < 20 min in case of meniscectomy | Non-New York residents, pts. that left against medical advice, mortalities, pts. < 18 yrs., surgeries from December 2013 |
| Co-interventions | NA | Trigger finger release, cubital tunnel relese, Guyon release, radial tunnel release, fasciotomy Dupuytren, other, standard postoperative care – nerve and tendon-gliding exercises | NA | NA | NA |
| Age, mean, yrs (range) | 38 (7–84) | 54 (41–67) | 56 (43.6–68.4) |
ACL: 29.4 (18.9–39.9) Men: 47.3 (31.9–62.7) |
Average 33.3 (22.0–46.6) |
| Sex, female:male, n | 4443:3801 | 986:359 | 3785-6188 |
ACL: 7481: 10,908i Men: 50,108:72,889j |
9811:17,049 |
| BMI ± SD | NA | 27 ± 5 | NA | NA | NA |
| Comorbidities | NA | Diabetes mellitus, Rheumatoid arthritis, Dupuytren’s disease, Trigger fingers, CMCI joint arthritis, compression neuropathy, tendinitis, history of wrist trauma, scaphotrapeziotrapezoidal joint arthritis, radiocarpal arthritis, peripheral neuropathy, cervical radioculopathy, ulnocarpal impingement | Mean Deyo score: 0.1–0.9 | NA | Mean Deyo score: 0.06 |
| Follow-up time, yrs | 10k | 0.5 | NA | NA | 30 days |
| Patients excluded from the analysis, n (%) | ? | 712 | 961 |
ACL: 14,050 Men: 72,585 |
NA |
| Efficacy | |||||
| Survival, % | At 2/5/10 yrs | ||||
| β Low | 86.5/78.5/72.7 | NA | NA | NA | NA |
| β Medium | 87.8/82.7/82.7 | ||||
| β High | 94.6/90.2/90.2 | ||||
| β Very high | 97.6/97.6/97.6 | ||||
| Reduction in pain score units on VAS scale, baseline/6 mo by volume, mean n (SD) | |||||
| β Low | NA | Low: 47/18l | NA | NA | NA |
| β Medium | Medium: 51/20 | ||||
| β High | High: 51/19 | ||||
| β P value | NA | ||||
| BCTQ, mean n | |||||
| β Symptom severity score | NA | Low&Medium&High: all 1.7m | NA | NA | NA |
| β Functional status score | NA | Low&Medium&High: all 1.7 | NA | NA | NA |
| Hospital based acute care within 30 days, odds ratio n at 5 years (p value) | |||||
| β Low volume | NA | NA | NA | NA | x |
| β Medium volume | NA | NA | NA | NA | 0.77 (p 0.059) |
| β High volume | NA | NA | NA | NA | 0.47 (p < 0.001) |
| Risk of reoperation, hazard ratio n (95% CI) | |||||
| β Low volume | x | ||||
| β Medium volume | 0.9x (CI-0.74) | NA | NA | NA | NA |
| β High volume | 0.42 (CI 0.32) | NA | NA | NA | NA |
| β Very high volume | 0.17 (CI 0.07) | NA | NA | NA | NA |
| Nonroutine disposition of pts at dischargen, surgeon, n (95% CI) | |||||
| β Low volume | NA | NA | 2.8x (0.9–9.1) | ACL: 0.9% Men: 1.4% | NA |
| β Medium volume | NA | NA | 1.5x (0.7–3.1) | ACL: 0.4% Men: 0.7% | NA |
| β High volume | NA | NA | x | ACL: 0.2% Men: 0.5% | NA |
| Nonroutine disposition of pts at discharge, hospital, n (95% CI) | |||||
| β Low volume | NA | NA | 2.1x (0.6–8.0) | ACL: 1% Men: 1.6% | NA |
| β Medium volume | NA | NA | 1.7x (0.2–11.6) | ACL: 0.2% Men: 1.2% | NA |
| β High volume | NA | NA | x | ACL: 0.3% Men: 0.2% | NA |
| Mean operating time volume, surgeon, min (±SD) | |||||
| β Low volume | NA | NA | 112 (4) | ACL: 149(9) Men: 72(6)o | NA |
| β Medium volume | NA | NA | 113 (4) | ACL: 137(9) Men: 64(6) | NA |
| β High volume | NA | NA | 102 (4) | ACL: 122(9) Men: 53(6) | NA |
| β p value | NA | NA | < 0.001 | NA | NA |
| Mean operating time volume, hospital, min (±SD) | |||||
| β Low volume | NA | NA | 111 | ACL: 150(9) Men: 71(5)15 | NA |
| β Medium volume | NA | NA | 109 | ACL: 132(9) Men: 66(6) | NA |
| β High volume | NA | NA | 105 | ACL: 129(14) Men: 52(6) | NA |
| LOS and surgeon volume, n (95% CI) | |||||
| β Low volume | NA | NA | 2.3x (1.2–4.4) | NA | NA |
| β Medium volume | NA | NA | 1.3x (0.7–2.6) | NA | NA |
| β High volume | NA | NA | x | NA | NA |
| LOS and hospital volume, n (95% CI) | |||||
| β Low volume | NA | NA | 0.5x (0.2–1.1) | NA | NA |
| β Medium volume | NA | NA | 1.1x (0.4–3.1) | NA | NA |
| β High volume | NA | NA | x | NA | NA |
| Safety | |||||
| SAE | NA | NA | NA | NA | NA |
| AEs, n (%) | NA (0.2)p | 23 (1.6) | NA | NA | Unclearq |
| β Day surgery related AEs | MI, ileus, pneumonia, sepsis, mechanical complication, hardware failure, DVT/PE, wound infection, dislocation/iatrogenic instability, major bleedr | Wound infection, wound dehiscence | NA | NA | NA |
ACL Anterior cruciate ligament, BCTQ Boston Carpal Tunnel Questionnaire, COI Conflict of interests, CTR Carpal tunnel release, DVT Deep vein thrombosis, ED Emergency department, HA Hip arthroscopy, LOS Length of stay, THA Total hip arthroplasty, Men Meniscectomy, MI Myocardial infarction, NA Not available, PE Pulmonary embolism
a1345 pts. included in the analysis
bNumber of pts. finally included in the analysis was 9973. Exclusion criteria were applied to exclude diagnoses, which outcomes were expected to differ from outcomes of the included indications
cNumber of pts. finally included in the analysis was 18,390 for ACL and 123,012 for meniscectomy
dIncluding 23 simultaneous bilateral and 408 staged bilateral procedures
eNumber of cases in the period of 1997–2000
fNumber of cases per 4 years
gNumber of cases per 5 years
hData missing on 123 pts. (0.01%)
iRecords missing on 1 pt
jRecords missing on 15 pts
kAnalysis of volume/risk of reoperation relationship assessed at 5 years
lThe scores were reported only in a table and so the following numbers are only authors’ estimates
mThe scores were reported only in a graph and so the following numbers are only authors’ estimates
nNonroutine disposition included transfer to another hospital, skilled nursing facility, intermediate care facility, or home health care. Routine disposition reflected patients who were discharged home
oOnly restricted to the New York state database pts
pThirty days procedural complication rate
qListed complication are not necessarily intervention related, they are merely the reasons due to which pts. visited EDs within 30 days of ACL surgery
rNot reported in what n of pts., nor in relationship to surgeon volume