Influence of Surgeon Volume on Inpatient Complications, Cost, and Length of Stay Following Total Ankle Arthroplasty.
BACKGROUND
Increased surgeon volume may be associated with improved outcomes following operative procedures. However, there is a lack of information on the effect of surgeon volume on inpatient adverse events and resource utilization following total ankle arthroplasty (TAA).


METHODS
A retrospective cohort study of TAA patients was performed using the Nationwide Inpatient Sample (NIS) from 2003 to 2009. High-volume surgeons were considered as those with volume ≥90th percentile of surgeons performing TAA. Multivariate regression was used to compare the rates of adverse events, hospital length of stay, and total hospital charges between surgeon volume categories.


RESULTS
A total of 4800 TAA patients were identified. The 90th percentile for surgeon volume was 21 cases per year. Mean length of stay was 2.8 ± 2.3 days and mean hospital charges were $45 963 ± $43 983. On multivariate analysis, high-volume surgeons had decreased overall complications (OR 0.5, P = .034) and rate of medial malleolus fracture (OR 0.1, P = .043), decreased length of stay (-0.9 days, P < .001), and decreased hospital charges (-$20 904, P < .001).


CONCLUSIONS
Surgeons with volume ≥90th percentile had a decreased rate of complications, decreased length of stay, and reduced hospital charges compared to other surgeons.


LEVEL OF EVIDENCE
Level III, comparative study.
['Basques|Bryce A|BA|', 'Bitterman|Adam|A|', 'Campbell|Kevin J|KJ|', 'Haughom|Bryan D|BD|', 'Lin|Johnny|J|', 'Lee|Simon|S|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D058737:Arthroplasty, Replacement, Ankle D002983:Clinical Competence D005260:Female D017048:Health Care Costs D006760:Hospitalization D006801:Humans D007902:Length of Stay D008297:Male D008875:Middle Aged D000072161:Orthopedic Surgeons D011183:Postoperative Complications D012044:Regression Analysis D012189:Retrospective Studies D055815:Young Adult
volume inpatient complications cost length of stay total ankle arthroplasty total ankle replacement