Background
Methods
Eligibility criteria
Information sources and study selection
Data extraction
Quality appraisal of studies
Results
Study selection
Study characteristics
Study design
Study | Patients (n) | Study design | Country | Year data collected | Data source | Outcomes |
---|---|---|---|---|---|---|
Kreder et al (2003) | 14352 | Retrospective | Canada | 1992-1996 | OHIP and CIHI | MR (in hospital), MR (90d), infection, revision, complication, LOS |
Katz et al (2004) | 80904 | Retrospective | US | 2000 | Medicare | MR (90d), MI, infection, pneumonia, PE |
Katz et al (2007) | 906 | Prospective | US | 2000 | Medicare, patient survey | WOMAC, patient satisfaction, 90 degree flexion, full extension |
Muilwijk et al (2007) | 6357 | Retrospective | Netherlands | 1996-2003 | Dutch Nosocomial Infection Surveillance Network | Infection |
Manley et al (2009) | 53971 | Retrospective | US | 1997-2004 | Medicare | 2, 5, 8 year implant survivorship |
Ong et al (2009) | NR | Retrospective | US | 1997-2004 | Medicare | Procedure duration |
Yasunaga et al (2009) | 3577 | Prospective | Japan | 2006-2007 | Web based surgeon survey | MR (in-hospital), infection, DVT, PE, pneumonia, LOS |
Paterson et al (2010) | 27217 | Retrospective | Canada | 2000-2004 | OHIP and CIHI | MR (90d), revision, readmission for surgery, LOS, complications |
Wei et al (2010) | 31618 | Retrospective | Taiwan | 2000-2003 | NHI | LOS, hospital charges, infection, complications |
Styron et al (2011) | 67713 | Retrospective | US | 2002 | HCUP database | LOS |
Baker et al (2011) | 260 | Retrospective | UK | 2006-2007 | Local Database and National Joint Registry | Transfusion rate |
Sample size
Patient data source
Defining surgeon volume
Study | Surgeon volume thresholds | Outcomes | Result | LV vs. HV surgeons | Adjusted odds ratios* (95% CI) | |||
---|---|---|---|---|---|---|---|---|
Low | Medium | High | V. High | |||||
Kreder et al (2003) | <14 | 14-42 | >42 | -- | LOS |
p < 0.05
|
11.5 vs 10.0 days
|
NR
|
MR (in-hospital) | NS | 0.5% vs 0.3% | NR | |||||
MR (90 day) | NS | 0.8% vs 0.4% | 1.76 (0.8-3.8) (LV:HV) | |||||
Infection (3 yr) | NS | 2.1% vs 2.3% | 0.88 (0.5-1.3)(LV:HV) | |||||
Revision (3 yr) | NS | 2.2% vs 1.9% | 1.00 (0.6-1.7)(LV:HV) | |||||
Medical complication | NS | 9% vs 11% | 0.98 (0.7-1.3)(LV:HV) | |||||
Katz et al (2004) | 1-12 | 13-25 | 26-50 | >50 | Pneumonia |
p < 0.01#
|
1.68% vs 1.02%
|
0.72 (0.54-0.95) (HV:LV)#
|
Infection |
p < 0.01#
|
0.55% vs 0.29%
|
0.62 (0.37-1.06) (HV:LV)#
| |||||
MI | NS | 0.8% vs 0.69% | 0.90 (0.64-1.28)(HV:LV) | |||||
PE | NS | 0.76% vs 0.74% | 1.06 (0.73-1.54)(HV:LV) | |||||
MR (90d) | NS | 0.67% vs 0.58% | 0.97 (0.66-1.43)(HV:LV) | |||||
Katz et al (2007) | 1-6 | > 6 | poor WOMAC score (score < 60) |
p < 0.05
|
22.6% vs 8.4%
|
2.1 (1.1-4.2) (LV:HV)
| ||
flex to 90 degrees |
p < 0.05
|
NR
|
2.9 (1.6-5.5) (LV:HV)
| |||||
full extension |
p < 0.05
|
NR
|
2.2 (1.1-4.4) (LV:HV)
| |||||
Dissatisfied with TKA | NS | NR | 1.4 (0.6-3.3)(LV:HV) | |||||
Muilwijk et al (2007) | 5 | -- | 12 | -- | Infection |
p < 0.05
|
4.9% vs 2.1%
|
0.43 (0.23-0.80) (HV:LV)
|
Manley et al (2009) | 1-12 | 13-25 | 26-50 | >50 | Early - mid term survivoship (8 years) | NS | NR | 0.94 (0.78-1.15)(LV:HV) |
Ong et al (2009) | 1-12 | 13-25 | 26-50 | >50 | Procedure duration |
p < 0.05
|
165 mins vs 135 mins
|
NR
|
Yasunaga et al (2009) | Used surgeon career volume of TKR as surgeon volume variable: <100, 100-499, >499 | Medical complication | NS | 7.7% vs 13.5% | 1.17 (0.66-2.07) (HV:LV) | |||
LOS | NS | 38.9 vs 35 days | NR | |||||
Paterson et al (2010) | 2-35 | 36-50 | 51-70 | >70 | LOS |
p < 0.05
|
NR
|
NR
|
MR | NS | 0.624% vs 0.547% | 1.02 (0.63-1.67)(HV:LV) | |||||
Readmission for surgery (1 yr) | NS | 0.594% vs 0.403% | 0.81 (0.41-1.62)(HV:LV) | |||||
Revision (1 yr) | NS | 1.279% vs 0.922% | 0.75 (0.51-1.09)(HV:LV) | |||||
Medical Complication | NS | 4.217% vs 4.553% | 0.90 (0.67-1.19)(HV:LV) | |||||
Wei et al (2010) | 1-3 | 4-9 | 10-463 | -- | LOS |
p < 0.05
|
10.79 vs 8.66 days
|
NR
|
Infection |
p < 0.05
|
0.99% vs 0.54%
|
2.31 (1.379-3.876) (LV:HV)
| |||||
Styron et al (2011) | 1-17 | 18-35 | 36-66 | >67 | LOS |
p < 0.05
|
4.14 vs 3.74 days
|
NR
|
Baker et al (2011) | 1-52 | >52 | Transfusion rate |
p < 0.05
|
13% vs 4%
|
NR
|
Examined outcomes
Study | Covariates controlled |
---|---|
Kreder et al (2003) | age, comorbidity, gender, diagnosis, hospital procedure volume |
Katz et al (2004) | age, gender, comorbidity, Medicaid eligibility, diagnosis, hospital procedure volume |
Katz et al (2007) | age, gender, race, education, diagnosis, income, comorbidity, preoperative patient reported outcome (WOMAC) |
Muilwijk et al (2007) | ASA class |
Manley et al (2009) | age, gender, race, diagnosis, hospital procedure volume, hospital teaching status, hospital ownership, hospital region, income |
Manley et al (2009) | age, gender, race, diagnosis, hospital procedure volume, hospital teaching status, hospital ownership, hospital region, income |
Ong et al (2009) | age, gender, comorbidity, race, diagnosis, Medicare eligibility, hospital teaching status, hospital ownership, hospital location, hospital size, hospital procedure volume |
Yasunaga et al (2009) | age, gender, BMI, diagnosis, comorbidity, hospital procedure volume |
Paterson et al (2010) | age, gender, comorbidity, diagnosis, hospital teaching status, hospital procedure volume |
Wei et al (2010) | age, gender, diagnosis, comorbidity, hospital ownership, hospital region |
Styron et al (2011) | age, gender, race, comorbidity, income, insurance status, geographic region, hospital region, hospital teaching status, hospital ownership, hospital size, hospital procedure volume |
Baker et al (2011) | age, surgeon volume, preoperative hemoglobin, gender, type of anaesthetic, ASA, surgeon experience, indication |