Association between surgeon grade and implant survival following hip and knee replacement: a systematic review and meta-analysis.

Autor:	Fowler TJ; Musculoskeletal Research Unit, Learning and Research Building, Southmead Hospital, University of Bristol Medical School, Bristol, UK t.j.fowler@bristol.ac.uk., Aquilina AL; Musculoskeletal Research Unit, Learning and Research Building, Southmead Hospital, University of Bristol Medical School, Bristol, UK., Blom AW; Musculoskeletal Research Unit, Learning and Research Building, Southmead Hospital, University of Bristol Medical School, Bristol, UK.; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, National Institute for Health Research, Bristol, UK., Sayers A; Musculoskeletal Research Unit, Learning and Research Building, Southmead Hospital, University of Bristol Medical School, Bristol, UK., Whitehouse MR; Musculoskeletal Research Unit, Learning and Research Building, Southmead Hospital, University of Bristol Medical School, Bristol, UK.; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, National Institute for Health Research, Bristol, UK.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2021 Nov 10; Vol. 11 (11), pp. e047882. Date of Electronic Publication: 2021 Nov 10.
DOI:	10.1136/bmjopen-2020-047882
Abstrakt:	Objective: To investigate the association between surgeon grade (trainee vs consultant) and implant survival following primary hip and knee replacement. Design: A systematic review and meta-analysis of observational studies. Data Sources: MEDLINE and Embase from inception to 6 October 2021. Setting: Units performing primary hip and/or knee replacements since 1990. Participants: Adult patients undergoing either a primary hip or knee replacement, predominantly for osteoarthritis. Intervention: Whether the surgeon recorded as performing the procedure was a trainee or not. Primary and Secondary Outcome Measures: The primary outcome was net implant survival reported as a Kaplan-Meier survival estimate. The secondary outcome was crude revision rate. Both outcomes were reported according to surgeon grade. Results: Nine cohort studies capturing 4066 total hip replacements (THRs), 936 total knee replacements (TKRs) and 1357 unicompartmental knee replacements (UKRs) were included (5 THR studies, 2 TKR studies and 2 UKR studies). The pooled net implant survival estimates for THRs at 5 years were 97.9% (95% CI 96.6% to 99.2%) for trainees and 98.1% (95% CI 97.1% to 99.2%) for consultants. The relative risk of revision of THRs at 5 and 10 years was 0.88 (95% CI 0.46 to 1.70) and 0.68 (95% CI 0.37 to 1.26), respectively. For TKRs, the net implant survival estimates at 10 years were 96.2% (95% CI 94.0% to 98.4%) for trainees and 95.1% (95% CI 93.0% to 97.2%) for consultants. We report a narrative summary of UKR outcomes. Conclusions: There is no strong evidence in the existing literature that trainee surgeons have worse outcomes compared with consultants, in terms of the net survival or crude revision rate of hip and knee replacements at 5-10 years follow-up. These findings are limited by the quality of the existing published data and are applicable to countries with established orthopaedic training programmes. Prospero Registration Number: CRD42019150494. Competing Interests: Competing interests: AWB and MRW declare support from The Healthcare Quality Improvement Partnership/The NJR in the form of the Lot 2 contract for statistical analysis of the NJR, outside the submitted work; AWB and MRW report grants from the NIHR investigating the outcomes of joint replacement, outside the submitted work; AWB and MRW are editors of an Orthopaedic textbook for which they receive royalty payments from Taylor Francis; MRW reports fees paid to their institution for delivering teaching at courses organised by DePuy and Heraeus. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu