The Effect of Hospital and Surgeon Volume on Complication Rates Following Fixation of Peritrochanteric Hip Fractures.

Introduction Hospital and surgeon volume are known to affect the outcomes of orthopaedic surgeries. The current study evaluates the relationship between hospital and surgeon volume of peritrochanteric hip fracture fixation and complication rates. Methods Adults (≥60 years old) who underwent surgical fixation for closed peritrochanteric fractures from 2009-2015 were identified using ICD-9/10 Clinical Modification and Procedural codes in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Readmission, reoperations, in-hospital mortality, and other adverse events were compared across surgeon and facility volumes. Statistical significance was set at P Results 29,656 patients were included. Low-volume (LV) facilities had higher rates of readmission (Hazard ratio (HR) 1.07, 95% Confidence Interval (CI) 1.05-1.17), pneumonia (HR 1.36, 95% CI 1.22-1.51), wound complications (HR 1.24, 95% CI 1.03-1.49) and mortality (HR 1.15, 95% CI 1.04-1.27), but lower rates of acute renal failure (HR 0.90, 95% CI 0.83-0.98), deep vein thrombosis (DVT) (HR 0.66, 95% CI 0.55-0.78), and acute respiratory failure (HR 0.77, 95% CI 0.62-0.95) than high-volume (HV) facilities. LV surgeons had lower rates of readmission (HR 0.92, 95% CI 0.87-0.97) and DVT (HR: 0.78, 95% CI 0.66-0.94) but higher rates of acute renal failure (HR: 1.13, 95% CI 1.04-1.22) than HV surgeons. Conclusion There are decreased rates of mortality, readmission, and certain complications when peritrochanteric femur fractures are surgically managed at LV hospitals compared to HV hospitals. Thus, the benefit of a high-volume surgical facility is apparent in mortality and readmissions, but not all complications. There was no significant decrease in complications if fixation was performed by HV surgeons relative to LV surgeons.