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Impact of centre volume, surgeon volume, surgeon experience and geographic location on reoperation after intramedullary nailing of tibial shaft fractures.

Publication ,  Journal Article
Swiontkowski, M; Teague, D; Sprague, S; Bzovsky, S; Heels-Ansdell, D; Bhandari, M; Schemitsch, EH; Sanders, DW; Tornetta, P; Walter, SD ...
Published in: Can J Surg
July 5, 2021

BACKGROUND: Tibial shaft fractures are the most common long-bone injury, with a reported annual incidence of more than 75 000 in the United States. This study aimed to determine whether patients with tibial fractures managed with intramedullary nails experience a lower rate of reoperation if treated at higher-volume hospitals, or by higher-volume or more experienced surgeons. METHODS: The Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) was a multicentre randomized clinical trial comparing reamed and nonreamed intramedullary nailing on rates of reoperation to promote fracture union, treat infection or preserve the limb in patients with open and closed fractures of the tibial shaft. Using data from SPRINT, we quantified centre and surgeon volumes into quintiles. We performed analyses adjusted for type of fracture (open v. closed), type of injury (isolated v. multitrauma), gender and age for the primary outcome of reoperation using multivariable logistic regression. RESULTS: There were no significant differences in the odds of reoperation between high- and low-volume centres (p = 0.9). Overall, surgeon volume significantly affected the odds of reoperation (p = 0.03). The odds of reoperation among patients treated by moderate-volume surgeons were 50% less than those among patients treated by verylow-volume surgeons (odds ratio [OR] 0.50, 95% confidence interval [CI] 0.28–0.88), and the odds of reoperation among patients treated by high-volume surgeons were 47% less than those among patients treated by very-low-volume surgeons (OR 0.53, 95% CI 0.30–0.93). CONCLUSION: There appears to be no significant additional patient benefit in treatment by a higher-volume centre for intramedullary fixation of tibial shaft fractures. Additional research on the effects of surgical and clinical site volume in tibial shaft fracture management is needed to confirm this finding. The odds of reoperation were higher in patients treated by very-low-volume surgeons; this finding may be used to optimize the results of tibial shaft fracture management. Clinical trial registration: ClinicalTrials.gov, NCT00038129

Duke Scholars

Published In

Can J Surg

DOI

EISSN

1488-2310

Publication Date

July 5, 2021

Volume

64

Issue

4

Start / End Page

E371 / E376

Location

Canada

Related Subject Headings

  • United States
  • Tibial Fractures
  • Surgery
  • Surgeons
  • Reoperation
  • Prospective Studies
  • Netherlands
  • Humans
  • Hospitals, Low-Volume
  • Hospitals, High-Volume
 

Citation

APA
Chicago
ICMJE
MLA
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Swiontkowski, M., Teague, D., Sprague, S., Bzovsky, S., Heels-Ansdell, D., Bhandari, M., … SPRINT Investigators, . (2021). Impact of centre volume, surgeon volume, surgeon experience and geographic location on reoperation after intramedullary nailing of tibial shaft fractures. Can J Surg, 64(4), E371–E376. https://doi.org/10.1503/cjs.004020
Swiontkowski, Marc, David Teague, Sheila Sprague, Sofia Bzovsky, Diane Heels-Ansdell, Mohit Bhandari, Emil H. Schemitsch, et al. “Impact of centre volume, surgeon volume, surgeon experience and geographic location on reoperation after intramedullary nailing of tibial shaft fractures.Can J Surg 64, no. 4 (July 5, 2021): E371–76. https://doi.org/10.1503/cjs.004020.
Swiontkowski M, Teague D, Sprague S, Bzovsky S, Heels-Ansdell D, Bhandari M, et al. Impact of centre volume, surgeon volume, surgeon experience and geographic location on reoperation after intramedullary nailing of tibial shaft fractures. Can J Surg. 2021 Jul 5;64(4):E371–6.
Swiontkowski, Marc, et al. “Impact of centre volume, surgeon volume, surgeon experience and geographic location on reoperation after intramedullary nailing of tibial shaft fractures.Can J Surg, vol. 64, no. 4, July 2021, pp. E371–76. Pubmed, doi:10.1503/cjs.004020.
Swiontkowski M, Teague D, Sprague S, Bzovsky S, Heels-Ansdell D, Bhandari M, Schemitsch EH, Sanders DW, Tornetta P, Walter SD, SPRINT Investigators. Impact of centre volume, surgeon volume, surgeon experience and geographic location on reoperation after intramedullary nailing of tibial shaft fractures. Can J Surg. 2021 Jul 5;64(4):E371–E376.

Published In

Can J Surg

DOI

EISSN

1488-2310

Publication Date

July 5, 2021

Volume

64

Issue

4

Start / End Page

E371 / E376

Location

Canada

Related Subject Headings

  • United States
  • Tibial Fractures
  • Surgery
  • Surgeons
  • Reoperation
  • Prospective Studies
  • Netherlands
  • Humans
  • Hospitals, Low-Volume
  • Hospitals, High-Volume