Bottle A, et al. – Authors here determine if early return to theatre (RTT) add value to rates of revision at 3 years in assessing surgeon performance for elective hip and knee arthroplasty. In this study, RTT at 90 days (RTT90) seems to provide useful and complementary information on surgeon performance and should be considered alongside revision rates, but low case loads considerably reduce the power to detect unusual performance on either metric.

Methods

• Authors utilized national hospital administrative data for England to compare RTT at 90 days (RTT90) with revision rates within 3 years by surgeon.
• In this study, standard power calculations were run for different scenarios.
• They used funnel plots to count the number of surgeons with unusually high or low rates.

Results

• From 2006 to 2011, authors identified 297 650 hip replacements (HRs) among 2952 surgeons and 341 226 knee replacements (KRs) among 2343 surgeons.
• They noticed RTT90 rates of 2.1% for HR and 1.5% for KR; 3-year revision rates of 2.1% for HR and 2.2% for KR were evident.
• Observations indicated that statistical power to detect surgeons with poor performance on either metric was particularly low for surgeons performing 50 cases per year for the 5 years.
• In this study, the correlation between the risk-adjusted surgeon-level rates for the two outcomes was +0.51 for HR and +0.20 for KR, both p<0.001.
• Little agreement was observed between the measures regarding which surgeons had significantly high or low rates.