Impact of centre volume, surgeon volume, surgeon experience and geographic location on reoperation after intramedullary nailing of tibial shaft fractures
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...
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| Veröffentlicht in: | Canadian Journal of Surgery 2021-07, Vol.64 (4), p.E371-E376 |
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| creator | Swiontkowski, Marc Teague, David Sprague, Sheila Bzovsky, Sofia Heels-Ansdell, Diane Bhandari, Mohit Schemitsch, Emil H Sanders, David W Tornetta, Paul, III Walter, Stephen D |
| description | 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 very-low-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 Contexte: La fracture de la diaphyse tibiale est la plus commune des fractures des os longs, avec une incidence annuelle declaree de plus 75 000 cas aux Etats-Unis. Cette etude visait a determiner si les patients traites par enclouage intra-medullaire pour une fracture du tibia sont moins souvent reoperes quand l'interventi |
| doi_str_mv | 10.1503/cjs.004020 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8410470</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A674713395</galeid><sourcerecordid>A674713395</sourcerecordid><originalsourceid>FETCH-LOGICAL-c544t-fd4739ff6bd851971af3b21dcdbb204528c33e2471665e5b25771cbf9c0eb60e3</originalsourceid><addsrcrecordid>eNptkl2L1DAUhoso7rh64y8oCouKHZM0_boRlsWPgUUvVPAupOlJJ0OadJN2WX-K_9ZTZ9EdHRIIOXny5pyTN0meUrKmBcnfqF1cE8IJI_eSFeV1nbGckvvJihBSZ5zV30-SRzHuCKEk583D5CTnjLGqoqvk52YYpZpSr1MFbgqQXns7D_A6jXPowbv_9nAzQjDgFKTSdSnG-iDHrVGp9UpOBhGcATxi-63UE4TUoLocoJutleFH6qSxxvXLw5NpjbRp3CKY6oDpzAHi4-SBljbCk9v1NPn2_t3Xi4_Z5ecPm4vzy0wVnE-Z7niVN1qXbVcXtKmo1HnLaKe6tmWEF6xWeQ6MV7QsCyhaVmDdqtWNItCWBPLT5O1ed5xbTO93F6QVYzAD5im8NOLwxJmt6P21qDklvCIo8OJWIPirGeIkBhMVYJkO_BwFK3hdNHVFc0Sf_4Pu_BwclodUWZa0xv_8S_XSgjBOe3xXLaLivKz4ItQUSGVHqB4ctt16B9pg-IB_doRXo7kSd6H1EQhHB4NRR1VfHlxAZoKbqZdzjGLz5dMhe3aH3YK00zaiuxaTxEPw1R5UwccYQP_5DUrEYnmBlhd7y-e_AInF8hM</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2566618503</pqid></control><display><type>article</type><title>Impact of centre volume, surgeon volume, surgeon experience and geographic location on reoperation after intramedullary nailing of tibial shaft fractures</title><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Swiontkowski, Marc ; Teague, David ; Sprague, Sheila ; Bzovsky, Sofia ; Heels-Ansdell, Diane ; Bhandari, Mohit ; Schemitsch, Emil H ; Sanders, David W ; Tornetta, Paul, III ; Walter, Stephen D</creator><creatorcontrib>Swiontkowski, Marc ; Teague, David ; Sprague, Sheila ; Bzovsky, Sofia ; Heels-Ansdell, Diane ; Bhandari, Mohit ; Schemitsch, Emil H ; Sanders, David W ; Tornetta, Paul, III ; Walter, Stephen D</creatorcontrib><description>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 very-low-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 Contexte: La fracture de la diaphyse tibiale est la plus commune des fractures des os longs, avec une incidence annuelle declaree de plus 75 000 cas aux Etats-Unis. Cette etude visait a determiner si les patients traites par enclouage intra-medullaire pour une fracture du tibia sont moins souvent reoperes quand l'intervention est effectuee dans des etablissements qui traitent de plus forts volumes de cas ou par des chirurgiens operant un plus fort volume de cas ou plus experimentes. Methodes: L'etude SPRINT (Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures) est un essai clinique multicentrique randomise qui a compare l'effet de l'enclouage alese c. non alese sur le taux des reinterventions visant a promouvoir la consolidation osseuse de la fracture, a traiter une infection ou a preserver le membre chez des patients victimes de fractures fermees ou ouvertes de la diaphyse tibiale. A partir des donnees de l'etude SPRINT, nous avons classe les etablissements et les chirurgiens en quintiles selon les volumes de cas traites. Nous avons effectue des analyses ajustees en fonction du type de fracture (ouverte c. fermee), du type de blessure (isolee c. polytraumatisme), du sexe et de l'age, pour etablir le taux de reintervention (parametre principal), en utilisant la regression logistique multivariee. Resultats: On n'a note aucune difference significative quant au risque de reinter-vention entre les centres qui traitaient des volumes eleves c. bas (p = 0,9). Dans l'ensemble le volume d'operations des chirurgiens a significativement influe sur le risque de reintervention (p = 0,03). Le risque de reintervention chez les patients traites par des chirurgiens dont le volume d'interventions etait moyen etait de 50 % de moins que chez les patients traites par des chirurgiens dont le volume etait tres bas (risque relatif [RR] 0,50, intervalle de confiance [IC] a 95 % 0,28-0,88) et le risque de reinter-vention chez les patients traites par des chirurgiens dont le volume etait tres eleve etait de 47 % de moins que chez les patients traites par des chirurgiens dont le volume etait tres bas (RR 0,53, IC a 95 % 0,30-0,93). Conclusion: Il ne semble y avoir aucun bienfait additionnel significatif au fait d'etre opere dans un centre ou le volume d'interventions pour enclouage intra-medullaire des fractures de la diaphyse tibiale est eleve. Il faudra approfondir la recherche sur les effets du volume chirurgical et de l'experience clinique des etablissements pour confirmer cette observation. Le risque de reintervention a ete plus eleve chez les patients traites par des chirurgiens dont le volume d'interventions etait tres bas; cette observation pourrait etre utilisee pour optimiser l'issue du traite-ment des fractures de la diaphyse tibiale. Enregistrement de l'essai clinique: ClinicalTrials.gov, NCT00038129.</description><identifier>ISSN: 0008-428X</identifier><identifier>EISSN: 1488-2310</identifier><identifier>DOI: 10.1503/cjs.004020</identifier><identifier>PMID: 34222771</identifier><language>eng</language><publisher>Ottawa: CMA Joule Inc</publisher><subject>Bone surgery ; Clinical outcomes ; Clinical trials ; Fractures ; Hospitals ; Infections ; Injuries ; Internal fixation in fractures ; Joint replacement surgery ; Joint surgery ; Leg ; Mortality ; Orthopedics ; Patient outcomes ; Patients ; Reoperation ; Statistics ; Supply and demand ; Surgeons</subject><ispartof>Canadian Journal of Surgery, 2021-07, Vol.64 (4), p.E371-E376</ispartof><rights>COPYRIGHT 2021 CMA Joule Inc.</rights><rights>Copyright Joule Inc Jul/Aug 2021</rights><rights>2021 CMA Joule Inc. or its licensors 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c544t-fd4739ff6bd851971af3b21dcdbb204528c33e2471665e5b25771cbf9c0eb60e3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8410470/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8410470/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids></links><search><creatorcontrib>Swiontkowski, Marc</creatorcontrib><creatorcontrib>Teague, David</creatorcontrib><creatorcontrib>Sprague, Sheila</creatorcontrib><creatorcontrib>Bzovsky, Sofia</creatorcontrib><creatorcontrib>Heels-Ansdell, Diane</creatorcontrib><creatorcontrib>Bhandari, Mohit</creatorcontrib><creatorcontrib>Schemitsch, Emil H</creatorcontrib><creatorcontrib>Sanders, David W</creatorcontrib><creatorcontrib>Tornetta, Paul, III</creatorcontrib><creatorcontrib>Walter, Stephen D</creatorcontrib><title>Impact of centre volume, surgeon volume, surgeon experience and geographic location on reoperation after intramedullary nailing of tibial shaft fractures</title><title>Canadian Journal of Surgery</title><description>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 very-low-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 Contexte: La fracture de la diaphyse tibiale est la plus commune des fractures des os longs, avec une incidence annuelle declaree de plus 75 000 cas aux Etats-Unis. Cette etude visait a determiner si les patients traites par enclouage intra-medullaire pour une fracture du tibia sont moins souvent reoperes quand l'intervention est effectuee dans des etablissements qui traitent de plus forts volumes de cas ou par des chirurgiens operant un plus fort volume de cas ou plus experimentes. Methodes: L'etude SPRINT (Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures) est un essai clinique multicentrique randomise qui a compare l'effet de l'enclouage alese c. non alese sur le taux des reinterventions visant a promouvoir la consolidation osseuse de la fracture, a traiter une infection ou a preserver le membre chez des patients victimes de fractures fermees ou ouvertes de la diaphyse tibiale. A partir des donnees de l'etude SPRINT, nous avons classe les etablissements et les chirurgiens en quintiles selon les volumes de cas traites. Nous avons effectue des analyses ajustees en fonction du type de fracture (ouverte c. fermee), du type de blessure (isolee c. polytraumatisme), du sexe et de l'age, pour etablir le taux de reintervention (parametre principal), en utilisant la regression logistique multivariee. Resultats: On n'a note aucune difference significative quant au risque de reinter-vention entre les centres qui traitaient des volumes eleves c. bas (p = 0,9). Dans l'ensemble le volume d'operations des chirurgiens a significativement influe sur le risque de reintervention (p = 0,03). Le risque de reintervention chez les patients traites par des chirurgiens dont le volume d'interventions etait moyen etait de 50 % de moins que chez les patients traites par des chirurgiens dont le volume etait tres bas (risque relatif [RR] 0,50, intervalle de confiance [IC] a 95 % 0,28-0,88) et le risque de reinter-vention chez les patients traites par des chirurgiens dont le volume etait tres eleve etait de 47 % de moins que chez les patients traites par des chirurgiens dont le volume etait tres bas (RR 0,53, IC a 95 % 0,30-0,93). Conclusion: Il ne semble y avoir aucun bienfait additionnel significatif au fait d'etre opere dans un centre ou le volume d'interventions pour enclouage intra-medullaire des fractures de la diaphyse tibiale est eleve. Il faudra approfondir la recherche sur les effets du volume chirurgical et de l'experience clinique des etablissements pour confirmer cette observation. Le risque de reintervention a ete plus eleve chez les patients traites par des chirurgiens dont le volume d'interventions etait tres bas; cette observation pourrait etre utilisee pour optimiser l'issue du traite-ment des fractures de la diaphyse tibiale. Enregistrement de l'essai clinique: ClinicalTrials.gov, NCT00038129.</description><subject>Bone surgery</subject><subject>Clinical outcomes</subject><subject>Clinical trials</subject><subject>Fractures</subject><subject>Hospitals</subject><subject>Infections</subject><subject>Injuries</subject><subject>Internal fixation in fractures</subject><subject>Joint replacement surgery</subject><subject>Joint surgery</subject><subject>Leg</subject><subject>Mortality</subject><subject>Orthopedics</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Reoperation</subject><subject>Statistics</subject><subject>Supply and demand</subject><subject>Surgeons</subject><issn>0008-428X</issn><issn>1488-2310</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNptkl2L1DAUhoso7rh64y8oCouKHZM0_boRlsWPgUUvVPAupOlJJ0OadJN2WX-K_9ZTZ9EdHRIIOXny5pyTN0meUrKmBcnfqF1cE8IJI_eSFeV1nbGckvvJihBSZ5zV30-SRzHuCKEk583D5CTnjLGqoqvk52YYpZpSr1MFbgqQXns7D_A6jXPowbv_9nAzQjDgFKTSdSnG-iDHrVGp9UpOBhGcATxi-63UE4TUoLocoJutleFH6qSxxvXLw5NpjbRp3CKY6oDpzAHi4-SBljbCk9v1NPn2_t3Xi4_Z5ecPm4vzy0wVnE-Z7niVN1qXbVcXtKmo1HnLaKe6tmWEF6xWeQ6MV7QsCyhaVmDdqtWNItCWBPLT5O1ed5xbTO93F6QVYzAD5im8NOLwxJmt6P21qDklvCIo8OJWIPirGeIkBhMVYJkO_BwFK3hdNHVFc0Sf_4Pu_BwclodUWZa0xv_8S_XSgjBOe3xXLaLivKz4ItQUSGVHqB4ctt16B9pg-IB_doRXo7kSd6H1EQhHB4NRR1VfHlxAZoKbqZdzjGLz5dMhe3aH3YK00zaiuxaTxEPw1R5UwccYQP_5DUrEYnmBlhd7y-e_AInF8hM</recordid><startdate>20210701</startdate><enddate>20210701</enddate><creator>Swiontkowski, Marc</creator><creator>Teague, David</creator><creator>Sprague, Sheila</creator><creator>Bzovsky, Sofia</creator><creator>Heels-Ansdell, Diane</creator><creator>Bhandari, Mohit</creator><creator>Schemitsch, Emil H</creator><creator>Sanders, David W</creator><creator>Tornetta, Paul, III</creator><creator>Walter, Stephen D</creator><general>CMA Joule Inc</general><general>CMA Impact, Inc</general><scope>AAYXX</scope><scope>CITATION</scope><scope>ISN</scope><scope>3V.</scope><scope>4T-</scope><scope>4U-</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FQ</scope><scope>8FV</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M3G</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210701</creationdate><title>Impact of centre volume, surgeon volume, surgeon experience and geographic location on reoperation after intramedullary nailing of tibial shaft fractures</title><author>Swiontkowski, Marc ; Teague, David ; Sprague, Sheila ; Bzovsky, Sofia ; Heels-Ansdell, Diane ; Bhandari, Mohit ; Schemitsch, Emil H ; Sanders, David W ; Tornetta, Paul, III ; Walter, Stephen D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c544t-fd4739ff6bd851971af3b21dcdbb204528c33e2471665e5b25771cbf9c0eb60e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Bone surgery</topic><topic>Clinical outcomes</topic><topic>Clinical trials</topic><topic>Fractures</topic><topic>Hospitals</topic><topic>Infections</topic><topic>Injuries</topic><topic>Internal fixation in fractures</topic><topic>Joint replacement surgery</topic><topic>Joint surgery</topic><topic>Leg</topic><topic>Mortality</topic><topic>Orthopedics</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Reoperation</topic><topic>Statistics</topic><topic>Supply and demand</topic><topic>Surgeons</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Swiontkowski, Marc</creatorcontrib><creatorcontrib>Teague, David</creatorcontrib><creatorcontrib>Sprague, Sheila</creatorcontrib><creatorcontrib>Bzovsky, Sofia</creatorcontrib><creatorcontrib>Heels-Ansdell, Diane</creatorcontrib><creatorcontrib>Bhandari, Mohit</creatorcontrib><creatorcontrib>Schemitsch, Emil H</creatorcontrib><creatorcontrib>Sanders, David W</creatorcontrib><creatorcontrib>Tornetta, Paul, III</creatorcontrib><creatorcontrib>Walter, Stephen D</creatorcontrib><collection>CrossRef</collection><collection>Gale In Context: Canada</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Canadian Business & Current Affairs Database</collection><collection>Canadian Business & Current Affairs Database (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>CBCA Reference & Current Events</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Canadian Journal of Surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Swiontkowski, Marc</au><au>Teague, David</au><au>Sprague, Sheila</au><au>Bzovsky, Sofia</au><au>Heels-Ansdell, Diane</au><au>Bhandari, Mohit</au><au>Schemitsch, Emil H</au><au>Sanders, David W</au><au>Tornetta, Paul, III</au><au>Walter, Stephen D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of centre volume, surgeon volume, surgeon experience and geographic location on reoperation after intramedullary nailing of tibial shaft fractures</atitle><jtitle>Canadian Journal of Surgery</jtitle><date>2021-07-01</date><risdate>2021</risdate><volume>64</volume><issue>4</issue><spage>E371</spage><epage>E376</epage><pages>E371-E376</pages><issn>0008-428X</issn><eissn>1488-2310</eissn><abstract>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 very-low-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 Contexte: La fracture de la diaphyse tibiale est la plus commune des fractures des os longs, avec une incidence annuelle declaree de plus 75 000 cas aux Etats-Unis. Cette etude visait a determiner si les patients traites par enclouage intra-medullaire pour une fracture du tibia sont moins souvent reoperes quand l'intervention est effectuee dans des etablissements qui traitent de plus forts volumes de cas ou par des chirurgiens operant un plus fort volume de cas ou plus experimentes. Methodes: L'etude SPRINT (Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures) est un essai clinique multicentrique randomise qui a compare l'effet de l'enclouage alese c. non alese sur le taux des reinterventions visant a promouvoir la consolidation osseuse de la fracture, a traiter une infection ou a preserver le membre chez des patients victimes de fractures fermees ou ouvertes de la diaphyse tibiale. A partir des donnees de l'etude SPRINT, nous avons classe les etablissements et les chirurgiens en quintiles selon les volumes de cas traites. Nous avons effectue des analyses ajustees en fonction du type de fracture (ouverte c. fermee), du type de blessure (isolee c. polytraumatisme), du sexe et de l'age, pour etablir le taux de reintervention (parametre principal), en utilisant la regression logistique multivariee. Resultats: On n'a note aucune difference significative quant au risque de reinter-vention entre les centres qui traitaient des volumes eleves c. bas (p = 0,9). Dans l'ensemble le volume d'operations des chirurgiens a significativement influe sur le risque de reintervention (p = 0,03). Le risque de reintervention chez les patients traites par des chirurgiens dont le volume d'interventions etait moyen etait de 50 % de moins que chez les patients traites par des chirurgiens dont le volume etait tres bas (risque relatif [RR] 0,50, intervalle de confiance [IC] a 95 % 0,28-0,88) et le risque de reinter-vention chez les patients traites par des chirurgiens dont le volume etait tres eleve etait de 47 % de moins que chez les patients traites par des chirurgiens dont le volume etait tres bas (RR 0,53, IC a 95 % 0,30-0,93). Conclusion: Il ne semble y avoir aucun bienfait additionnel significatif au fait d'etre opere dans un centre ou le volume d'interventions pour enclouage intra-medullaire des fractures de la diaphyse tibiale est eleve. Il faudra approfondir la recherche sur les effets du volume chirurgical et de l'experience clinique des etablissements pour confirmer cette observation. Le risque de reintervention a ete plus eleve chez les patients traites par des chirurgiens dont le volume d'interventions etait tres bas; cette observation pourrait etre utilisee pour optimiser l'issue du traite-ment des fractures de la diaphyse tibiale. Enregistrement de l'essai clinique: ClinicalTrials.gov, NCT00038129.</abstract><cop>Ottawa</cop><pub>CMA Joule Inc</pub><pmid>34222771</pmid><doi>10.1503/cjs.004020</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0008-428X |
| ispartof | Canadian Journal of Surgery, 2021-07, Vol.64 (4), p.E371-E376 |
| issn | 0008-428X 1488-2310 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8410470 |
| source | EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Bone surgery Clinical outcomes Clinical trials Fractures Hospitals Infections Injuries Internal fixation in fractures Joint replacement surgery Joint surgery Leg Mortality Orthopedics Patient outcomes Patients Reoperation Statistics Supply and demand Surgeons |
| title | Impact of centre volume, surgeon volume, surgeon experience and geographic location on reoperation after intramedullary nailing of tibial shaft fractures |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-25T00%3A37%3A00IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Impact%20of%20centre%20volume,%20surgeon%20volume,%20surgeon%20experience%20and%20geographic%20location%20on%20reoperation%20after%20intramedullary%20nailing%20of%20tibial%20shaft%20fractures&rft.jtitle=Canadian%20Journal%20of%20Surgery&rft.au=Swiontkowski,%20Marc&rft.date=2021-07-01&rft.volume=64&rft.issue=4&rft.spage=E371&rft.epage=E376&rft.pages=E371-E376&rft.issn=0008-428X&rft.eissn=1488-2310&rft_id=info:doi/10.1503/cjs.004020&rft_dat=%3Cgale_pubme%3EA674713395%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2566618503&rft_id=info:pmid/34222771&rft_galeid=A674713395&rfr_iscdi=true |