Kaij Treskes1, Stijn C Voeten2, Maria C J M Tol3, Wietse P Zuidema2, Jefrey Vermeulen4, J Carel Goslings3, Niels W L Schep5, JG Han van den Brand6, Romuald van Velde7, Robert Haverlag8, Jan M Ultee8, Victor A Postma9, Bas A Twigt10, Bart A van Dijkman11, Pieter Heres12, Jasper Winkelhagen13, Mariska Klooster14, Annelies Toor15. 1. Trauma Unit, Academic Medical Centre, Amsterdam, Netherlands. Electronic address: k.treskes@amc.nl. 2. Department of traumasurgery, Vrije Universiteit Medical Centre, Amsterdam, Netherlands. 3. Trauma Unit, Academic Medical Centre, Amsterdam, Netherlands. 4. Department of surgery, Spaarne Gasthuis Hospital, Haarlem, Netherlands. 5. Department of surgery, Maasstad hospital, Rotterdam, Netherlands. 6. Medical Centre Alkmaar, Netherlands 7. Tergooi Hospital, Hilversum, Netherlands 8. Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, Netherlands 9. MC Group, Lelystad, Netherlands 10. BovenIJ Hospital, Amsterdam, Netherlands 11. Flevo Hospital, Almere, Netherlands 12. Waterland Hospital, Purmerend, Netherlands 13. Westfriesgasthuis Hospital, Hoorn, Netherlands 14. TraumaNet AMC, Netherlands 15. Netwerk Acute Zorg VUmc, Netherlands
Abstract
INTRODUCTION: Surgery for proximal femoral fractures in the Netherlands is performed by trauma surgeons, general surgeons and orthopaedic surgeons. The aim of this study was to assess whether there is a difference in outcome for patients with proximal femoral fractures operated by trauma surgeons versus general surgeons. Secondly, the relation between hospital and surgeon volume and postoperative complications was explored. METHODS: Patients of 18 years and older were included if operated for a proximal femoral fracture by a trauma surgeon or a general surgeon in two academic, eight teaching and two non-teaching hospitals in the Netherlands from January 2010 until December 2013. The combined endpoint was defined as reoperation or surgical site infection. Multivariate analysis was used to adjust for patient and fracture characteristics and hospital and surgeon volume. Categories for hospital volume were>170/year (high volume), 96-170/year (medium volume) and <96/year (low volume). RESULTS: In 4552 included patients 2382 (52.3%) had surgery by a trauma surgeon. Postoperative complications occurred in 276 (11.6%) patients operated by a trauma surgeon and in 258 (11.9%) operated by a general surgeon (p=0.751). When considering confounders in a multivariate analysis, surgery by trauma surgeons was associated with less postoperative complications (OR 0.746; 95%CI 0.580-0.958; p=0.022). Surgery in high volume hospitals was also associated with less complications (OR 0.997; 95%CI 0.995-0.999; p=0.012). Surgeon volume was not associated with complications (OR 1.008; 95%CI 0.997-1.018; p=0.175). CONCLUSION: Surgery by trauma surgeons and high hospital volume are associated with less reoperations and surgical site infections for patients with proximal femoral fractures.
INTRODUCTION: Surgery for proximal femoral fractures in the Netherlands is performed by trauma surgeons, general surgeons and orthopaedic surgeons. The aim of this study was to assess whether there is a difference in outcome for patients with proximal femoral fractures operated by trauma surgeons versus general surgeons. Secondly, the relation between hospital and surgeon volume and postoperative complications was explored. METHODS:Patients of 18 years and older were included if operated for a proximal femoral fracture by a trauma surgeon or a general surgeon in two academic, eight teaching and two non-teaching hospitals in the Netherlands from January 2010 until December 2013. The combined endpoint was defined as reoperation or surgical site infection. Multivariate analysis was used to adjust for patient and fracture characteristics and hospital and surgeon volume. Categories for hospital volume were>170/year (high volume), 96-170/year (medium volume) and <96/year (low volume). RESULTS: In 4552 included patients 2382 (52.3%) had surgery by a trauma surgeon. Postoperative complications occurred in 276 (11.6%) patients operated by a trauma surgeon and in 258 (11.9%) operated by a general surgeon (p=0.751). When considering confounders in a multivariate analysis, surgery by trauma surgeons was associated with less postoperative complications (OR 0.746; 95%CI 0.580-0.958; p=0.022). Surgery in high volume hospitals was also associated with less complications (OR 0.997; 95%CI 0.995-0.999; p=0.012). Surgeon volume was not associated with complications (OR 1.008; 95%CI 0.997-1.018; p=0.175). CONCLUSION: Surgery by trauma surgeons and high hospital volume are associated with less reoperations and surgical site infections for patients with proximal femoral fractures.
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