Aims This study evaluates the association between consultant and hospital volume and the risk of re-revision and 90-day mortality following first-time revision of primary hip arthroplasty for aseptic loosening. Methods We conducted a cohort study of first-time, single-stage revision hip arthroplasties (RHAs) performed for aseptic loosening and recorded in the National Joint Registry (NJR) data for England, Wales, Northern Ireland, and the Isle of Man between 2003 and 2019. Patient identifiers were used to link records to national mortality data, and to NJR data to identify subsequent re-revision procedures. Multivariable Cox proportional hazard models with restricted cubic splines were used to define associations between volume and outcome. Results Among 12,961 RHAs there were 513 re-revisions within two years, and 95 deaths within 90 days of surgery. The risk of re-revision was highest for a consultant's first RHA (hazard ratio (HR) 1.56 (95% CI 1.15 to 2.12)) and remained significantly elevated for their first 24 cases (HR 1.26 (95% CI 1.00 to 1.58)). Annual consultant volumes of five/year were associated with an almost 30% greater risk of re-revision (HR 1.28 (95% CI 1.00 to 1.64)) and 80% greater risk of 90-day mortality (HR 1.81 (95% CI 1.02 to 3.21)) compared to volumes of 20/year. RHAs performed at hospitals which had cumulatively undertaken fewer than 167 RHAs were at up to 70% greater risk of re-revision (HR 1.70 (95% CI 1.12 to 2.59)), and those having undertaken fewer than 307 RHAs were at up to three times greater risk of 90-day mortality (HR 3.05 (95% CI 1.19 to 7.82)). Conclusion This study found a significantly higher risk of re-revision and early postoperative mortality following first-time single-stage RHA for aseptic loosening when performed by lower-volume consultants and at lower-volume institutions, supporting the move towards the centralization of such cases towards higher-volume units and surgeons.

中文翻译：

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外科医生和医院的体积与首次翻修髋关节置换术无菌松动结局之间的关联。


目的 本研究评估顾问和医院数量与初次翻修髋关节置换术后无菌松动后再翻修和 90 天死亡率风险之间的关联。方法 我们对 2003 年至 2019 年间英格兰、威尔士、北爱尔兰和马恩岛的国家联合登记处 （NJR） 数据中进行了首次单期翻修髋关节置换术 （RHA） 的队列研究。患者标识符用于将记录与国家死亡率数据相关联，并与 NJR 数据相关联，以确定后续的重新修订程序。使用具有受限立方样条的多变量 Cox 比例风险模型来定义体积和结果之间的关联。结果 在 12,961 例 RHA 中，2 年内有 513 例翻修，术后 90 天内有 95 例死亡。顾问的第一次 RHA 的再翻修风险最高 （风险比 （HR） 1.56 （95% CI 1.15 - 2.12）），并且前 24 例 RHA 仍然显著升高 （HR 1.26 （95% CI 1.00 - 1.58））。与 20 次/年相比，每年 5 次顾问就诊量与再翻修风险增加近 30% （HR 1.28 （95% CI 1.00， 1.64）） 和 90 天死亡风险增加 80% 相关 （HR 1.81 （95% CI 1.02， 3.21））。在累计进行少于 167 次 RHA 的医院进行的 RHA 复发风险高出 70% （HR 1.70 （95% CI 1.12， 2.59）），而进行少于 307 次 RHA 的医院进行 RHA 的 90 天死亡风险高出三倍 （HR 3.05 （95% CI 1.19， 7.82））。 结论 这项研究发现，当由低容量顾问和低容量机构进行无菌松动的首次单期 RHA 后，再翻修和术后早期死亡的风险显着增加，这支持将此类病例集中到高容量的病房和外科医生。