OTA 2006 Posters
Scientific Poster #57 Pelvis
Does Operative Volume Affect Outcomes for Open Reduction and Internal
Fixation of the Pelvis and Acetabulum?
James W. Genuario, MD (n); Kenneth J. Koval, MD (n);
Robert V. Cantu, MD (*); Kevin Spratt, PhD (n);
Dartmouth Hitchcock Medical Center, Department of Orthopaedic Surgery, Lebanon,
New Hampshire, USA
Background: Some propose that pelvic and acetabulum surgical repairs
are best treated in high-volume centers. These operations can require extensive
surgical experience, with specialized perioperative care and equipment.
To date, no study has examined the effect of hospital surgical volume on
outcome for open reduction and internal fixation (ORIF) of these fractures.
We hypothesized that higher hospital volume rates result in better outcomes
for ORIF of pelvic and acetabular fractures as defined by length of stay
(LOS), mortality, and both intra- and postoperative complications.
Methods: Data on patients undergoing ORIF from 1998-2003 for pelvic
and acetabular fractures were extracted from the National Trauma Database. Patients were divided into
three groups based on hospital volume: small volume (S: <2 procedures/month);
moderate volume (M: 2 and <5/month); and high volume (H: 5/month). Analysis
of covariance for continuous outcomes and logistic regression for dichotomous
outcomes were used to evaluate differences in LOS, in-hospital mortality,
and both intra- and postoperative in-hospital complication rates adjusting
for Injury Severity Score and comorbidities (Deyo-Charlson comorbidity index).
Results: 9105 patients met the inclusion criteria. As hypothesized:
(1) LOS was shorter (S = 15.7, M = 15.6, H = 14.0 days, adjusted) for H
hospitals (p < .0001); and (2) in-hospital mortality was lower in higher
volume hospitals (S = 2.5%, M = 1.1%, H = 0.7%), with adjusted odds ratios
for mortality of (a) S vs. M: 2.11 (95% CI 1.43-3.12); (b) S vs. H: 3.61
(95% CI 2.15-6.04); and (c) M vs. H: 1.70 (95% CI 0.96-2.99). Contrary to
our hypothesis: (1) no significant differences in intraoperative complication
rates were observed (S = 1.5%, M = 1.4%, H = 1.6%; P <0.38, adjusted);
and (2) differences observed for the postoperative complications favored
the small-volume hospitals (S = 0.73%, M = 0.98%, H = 1.32%; P <0.01,
adjusted).
Conclusion: As hypothesized, higher volume hospitals were associated
with decreased LOS and mortality rates. In general, both intra- and postoperative
complication rates were low. Intraoperative complication rates were not
associated with volume, but volume was directly related to postoperative
complications. These higher postoperative complication rates in conjunction
with lower mortality and LOS may suggest low clinical relevance. Thus, these
results provide initial evidence supporting the proposal that pelvic and
acetabulum surgical repairs are best treated in high-volume centers.
If noted, the author indicates something of value received.
The codes are identified as a-research or institutional support; b-miscellaneous
funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts
disclosed, and *disclosure not available at time of printing.
·
The FDA has not cleared this drug and/or medical device for the use
described in this presentation (i.e., the drug or medical device is being
discussed for an "off label" use). · · FDA
information not available at time of printing.