Fahim Anwar1, Kalpesh Shah2, Ian McLean3. 1. Spinal Injuries Unit, Institute of Neurological Sciences, Southern General Hospital, Glasgow G51 4TF, United Kingdom. 2. Trauma & Orthopaedics, Southern General Hospital, Glasgow G51 4TF, United Kingdom. 3. Department of Orthopaedics, Dumfries and Galloway Royal Infirmary, Dumfries DG1 4AP, United Kingdom.
Abstract
INTRODUCTION: Mortality and morbidity are both increased during revision hip surgery. Higher hospital procedure volumes have been associated with lower rates of mortality and/or complications according to some reports - the "practice makes perfect" hypothesis. AIM: The aim of the study was to test "practice makes perfect; hypothesis with regards to revision hip surgery at our low volume hospital. METHODS: This is a retrospective study of all the patients who underwent revision hip arthroplasty under the care of the senior author between February 2002 and January 2006. Data was collected about the 30-day and one-year mortality, post-operative complications like deep vein thrombosis (DVT), pulmonary embolism (PE), superficial or deep wound infections, dislocations, and the Oxford hip score. RESULTS: The rate of revision hip surgery carried out in our hospital was 6.25 per year. There was no 30-day mortality, stroke within 3 months, dislocations within one year, re-admission within one month, one-year mortality and deep infections within one year. The final outcome after revision hip surgery, based on Oxford questionnaire, showed that 72% had an excellent outcome and 8% had poor outcome. CONCLUSION: Volume and outcome relationship may not contribute towards the final outcome when individual surgeons and hospitals are considered. Good general hospital care can greatly affect the health outcome for a particular procedure. Strategies aimed at improving the general hospital care may benefit the patients as much as volume based regionalization.
INTRODUCTION: Mortality and morbidity are both increased during revision hip surgery. Higher hospital procedure volumes have been associated with lower rates of mortality and/or complications according to some reports - the "practice makes perfect" hypothesis. AIM: The aim of the study was to test "practice makes perfect; hypothesis with regards to revision hip surgery at our low volume hospital. METHODS: This is a retrospective study of all the patients who underwent revision hip arthroplasty under the care of the senior author between February 2002 and January 2006. Data was collected about the 30-day and one-year mortality, post-operative complications like deep vein thrombosis (DVT), pulmonary embolism (PE), superficial or deep wound infections, dislocations, and the Oxford hip score. RESULTS: The rate of revision hip surgery carried out in our hospital was 6.25 per year. There was no 30-day mortality, stroke within 3 months, dislocations within one year, re-admission within one month, one-year mortality and deep infections within one year. The final outcome after revision hip surgery, based on Oxford questionnaire, showed that 72% had an excellent outcome and 8% had poor outcome. CONCLUSION: Volume and outcome relationship may not contribute towards the final outcome when individual surgeons and hospitals are considered. Good general hospital care can greatly affect the health outcome for a particular procedure. Strategies aimed at improving the general hospital care may benefit the patients as much as volume based regionalization.
Entities:
Keywords:
Hip replacement; Hospital; Volume–outcome relationship
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