Low confidence in the cumulative evidence for the existence of a volume-outcome relationship after revision total knee replacement: A systematic review and meta-analysis.
Alexander H Matthews, Thomas Stringfellow, Hayley Redman, William K Gray, Jonathan P Evans, Jonathan T Evans, Sarah E Lamb, Tim Briggs, Andrew Price, Andrew D Toms
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引用次数: 0
Abstract
Purpose: This systematic review and meta-analysis aimed to establish the relationship between the number of procedures a hospital or surgeon performs with outcomes following revision knee replacement (RevKR).
Methods: MEDLINE and Embase were searched using Ovid silver platter up to December 2024 for randomised controlled trials and cohort studies that reported RevKR volumes, in at least two categories, performed by hospitals and surgeons and their relationship to patient and provider level outcomes. The primary outcome was re-revision rate. Secondary outcomes included mortality, post-operative complications, patient-reported outcomes measures (PROMs), emergency readmissions and hospital length of stay. The effect estimates were pooled and plotted using a random-effects, non-linear dose-response meta-analysis (DRMA). Where limitations in the data prohibited DRMA, a narrative approach was utilised. ROBINS-I and the GRADE approach were used to assess the risk of bias and the confidence in the cumulative evidence, respectively.
Results: A total of 10 cohort studies with data from 1993 to 2021 were included. The confidence in the cumulative evidence exploring the relationship between surgeon/hospital volume and all outcomes after RevKR was very low. An inconsistent relationship was seen between hospital and surgeon volume and re-revision at any point. There was a non-linear dose-response relationship between higher hospital volume and lower odds of adverse post-operative events (p < 0.05, n = 3 studies, n = 35,524 patients). There was no association between increased surgeon volumes and improvements in PROMs (n = 2 studies, n = 2289).
Conclusion: There is a lack of high-quality studies establishing the relationship between the number of procedures a hospital or surgeon performs and outcomes following RevKR. Studies are limited to observational designs and are difficult to effectively power due to the rarity of outcomes. Pooling data from multiple studies provides valuable insights but highlights significant heterogeneity and limitations in the existing literature.
Level of evidence: Level III, systematic review-lowest level of evidence analysed-was from retrospective cohort study of prospectively collected data.
期刊介绍：
Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication.
The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance.
Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards.
Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).
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