Key result
Higher hospital volume was not significantly associated with lower in-hospital mortality (aOR 0.87; 95% CI 0.73-1.04) or fewer postoperative complications in hip fracture patients.
Why the study?
Hospitals and surgeons with high hip fracture caseloads are hypothesized to have better outcomes, but empirical studies have reported contradictory results.
Does high hospital or surgeon volume improve in-hospital mortality and postoperative complications in patients with hip fractures?
Meta-Analysis (n=2,023,469)
Does high hospital or surgeon volume improve in-hospital mortality and postoperative complications in patients with hip fractures?
Odds Ratio: 0.87 (95% CI 0.73–1.04)
This meta-analysis found no statistically significant association between hospital or surgeon volume and in-hospital mortality or postoperative complications for hip fracture patients.
No volume-outcome link seen for hip fractures; leaves open whether centralization improves care or if other factors predominate.
Background and purpose - It has been hypothesized that hospitals and surgeons with high caseloads of hip fracture patients have better outcomes, but empirical studies have reported contradictory results. This systematic review and meta-analysis evaluates the volume-outcome relationship among patients with hip fracture patients. Methods - A search of different databases was performed up to February 2018. Selection of relevant studies, data extraction, and critical appraisal of the methodological quality was performed by 2 independent reviewers. A random-effects meta-analysis using studies with comparative cut-offs was performed to estimate the effect of hospital and surgeon volume on outcome, defined as in-hospital mortality and postoperative complications. Results - 24 studies comprising 2,023,469 patients were included. Overall, the quality was reasonable. 11 studies reported better health outcomes in high-volume centers and 2 studies reported better health outcomes in low-volume centers. In the meta-analysis of 11 studies there was a statistically non-significant association between higher hospital volume and both lower in-hospital mortality (adjusted odds ratio (aOR) 0.87, 95% confidence interval (CI) 0.73-1.04) and fewer postoperative complications (aOR 0.87, CI 0.75-1.02). Four studies on surgeon volume were included in the meta-analysis and showed a minor association between higher surgeon volume and in-hospital mortality (aOR 0.92, CI 0.76-1.12). Interpretation - This systematic review and meta-analysis did not find an evident effect of hospital or surgeon volume on health outcomes. Future research without volume cut-offs is needed to examine whether a true volume-outcome relationship exists.
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Wiegers et al. (2019) conducted a meta-analysis in Hip fracture (n=2,023,469). High hospital volume vs. Low hospital volume was evaluated on In-hospital mortality (aOR 0.87, 95% CI 0.73-1.04). Higher hospital volume was not significantly associated with lower in-hospital mortality (aOR 0.87; 95% CI 0.73-1.04) or fewer postoperative complications in hip fracture patients.
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