scholarly journals Hospital volume–outcome relationship in total knee arthroplasty: a systematic review and dose–response meta-analysis

2021 ◽  
Author(s):  
C. M. Kugler ◽  
K. Goossen ◽  
T. Rombey ◽  
K. K. De Santis ◽  
T. Mathes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Dose Response ◽  
Hospital Volume ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Early Revision ◽  
Outcome Relationship ◽  
Volume Outcome ◽  
Total Knee ◽  
Cumulative Evidence

Abstract Purpose This systematic review and dose–response meta-analysis aimed to investigate the relationship between hospital volume and outcomes for total knee arthroplasty (TKA). Methods MEDLINE, Embase, CENTRAL and CINAHL were searched up to February 2020 for randomised controlled trials and cohort studies that reported TKA performed in hospitals with at least two different volumes and any associated patient-relevant outcomes. The adjusted effect estimates (odds ratios, OR) were pooled using a random-effects, linear dose–response meta-analysis. Heterogeneity was quantified using the I2-statistic. 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 68 cohort studies with data from 1985 to 2018 were included. The risk of bias for all outcomes ranged from moderate to critical. Higher hospital volume may be associated with a lower rate of early revision ≤ 12 months (narrative synthesis of k = 7 studies, n = 301,378 patients) and is likely associated with lower mortality ≤ 3 months (OR = 0.91 per additional 50 TKAs/year, 95% confidence interval [0.87–0.95], k = 9, n = 2,638,996, I2 = 51%) and readmissions ≤ 3 months (OR = 0.98 [0.97–0.99], k = 3, n = 830,381, I2 = 44%). Hospital volume may not be associated with the rates of deep infections within 1–4 years, late revision (1–10 years) or adverse events ≤ 3 months. The confidence in the cumulative evidence was moderate for mortality and readmission rates; low for early revision rates; and very low for deep infection, late revision and adverse event rates. Conclusion An inverse volume–outcome relationship probably exists for some TKA outcomes, including mortality and readmissions, and may exist for early revisions. Small reductions in unfavourable outcomes may be clinically relevant at the population level, supporting centralisation of TKA to high-volume hospitals. Level of evidence III. Registration number The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42019131209 available at: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=131209).

scholarly journals Perspective of potential patients on the hospital volume-outcome relationship and the minimum volume threshold for total knee arthroplasty: a qualitative focus group and interview study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Charlotte M. Kugler ◽  
Karina K. De Santis ◽  
Tanja Rombey ◽  
Kaethe Goossen ◽  
Jessica Breuing ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Focus Group ◽  
Knee Arthroplasty ◽  
Hospital Volume ◽  
Minimum Volume ◽  
Outcome Relationship ◽  
Volume Outcome ◽  
Total Knee ◽  
Minimum Volume Threshold

Abstract Background Total knee arthroplasty (TKA) is performed to treat end-stage knee osteoarthritis. In Germany, a minimum volume threshold of 50 TKAs/hospital/year was implemented to ensure outcome quality. This study, embedded within a systematic review, aimed to investigate the perspectives of potential TKA patients on the hospital volume-outcome relationship for TKA (higher volumes associated with better outcomes). Methods A convenience sample of adults with knee problems and heterogeneous demographic characteristics participated in the study. Qualitative data were collected during a focus group prior to the systematic review (n = 5) and during telephone interviews, in which preliminary results of the systematic review were discussed (n = 16). The data were synthesised using content analysis. Results All participants (n = 21) believed that a hospital volume-outcome relationship exists for TKA while recognising that patient behaviour or the surgeon could also influence outcomes. All participants would be willing to travel longer for better outcomes. Most interviewees would choose a hospital for TKA depending on reputation, recommendations, and service quality. However, some would also choose a hospital based on the results of the systematic review that showed slightly lower mortality/revision rates at higher-volume hospitals. Half of the interviewees supported raising the minimum volume threshold even if this were to increase travel time to receive TKA. Conclusions Potential patients believe that a hospital volume-outcome relationship exists for TKA. Hospital preference is based mainly on subjective factors, although some potential patients would consider scientific evidence when making their choice. Policy makers and physicians should consider the patient perspectives when deciding on minimum volume thresholds or recommending hospitals for TKA, respectively.

Systematic review and meta-analysis of the volume-outcome relationship in pancreatic surgery

2011 ◽  
Vol 98 (4) ◽  
pp. 485-494 ◽  
Author(s):  
G. A. Gooiker ◽  
W. van Gijn ◽  
M. W. J. M. Wouters ◽  
P. N. Post ◽  
C. J. H. van de Velde ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Surgery ◽  
Meta Analysis ◽  
Outcome Relationship ◽  
Volume Outcome

Systematic review and meta-analysis on volume-outcome relationship of abdominal surgical procedures in Germany

2021 ◽  
Vol 86 ◽  
pp. 24-31 ◽  
Author(s):  
Anne Hendricks ◽  
Johannes Diers ◽  
Philip Baum ◽  
Stephanie Weibel ◽  
Carolin Kastner ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Procedures ◽  
Meta Analysis ◽  
Outcome Relationship ◽  
Volume Outcome ◽  
Relationship Of

scholarly journals The relationship between procedural volume and patient outcomes for percutaneous coronary interventions: a systematic review and meta-analysis

2021 ◽  
Vol 4 ◽  
pp. 10
Author(s):  
Kieran A. Walsh ◽  
Thomas Plunkett ◽  
Kirsty K. O'Brien ◽  
Conor Teljeur ◽  
Susan M. Smith ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
High Volume ◽  
Percutaneous Coronary Interventions ◽  
Procedural Volume ◽  
Outcome Relationship ◽  
Percutaneous Coronary ◽  
Volume Outcome ◽  
Secondary Outcomes ◽  
The Relationship

Background: The relationship between procedural volume and outcomes for percutaneous coronary interventions (PCI) is contentious, with previous reviews suggesting an inverse volume-outcome relationship. The aim of this study was to systematically review contemporary evidence to re-examine this relationship. Methods: A systematic review and meta-analysis was undertaken to examine the relationship between PCI procedural volume (both at hospital- and operator-levels) and outcomes in adults. The primary outcome was mortality. The secondary outcomes were complications, healthcare utilisation and process outcomes. Searches were conducted from 1 January 2008 to 28 May 2019. Certainty of the evidence was assessed using ‘Grading of Recommendations, Assessment, Development and Evaluations’ (GRADE). Screening, data extraction, quality appraisal and GRADE assessments were conducted independently by two reviewers. Results: Of 1,154 unique records retrieved, 22 observational studies with 6,432,265 patients were included. No significant association was found between total PCI hospital volume and mortality (odds ratio [OR]: 0.84, 95% confidence interval [CI]: 0.69-1.03, I2 = 86%). A temporal trend from significant to non-significant pooled effect estimates was observed. The pooled effect estimate for mortality was found to be significantly in favour of high-volume operators for total PCI procedures (OR: 0.77, 95% CI: 0.63-0.94, I2 = 93%), and for high-volume hospitals for primary PCI procedures (OR: 0.77, 95% CI: 0.62-0.94, I2 = 78%). Overall, GRADE certainty of evidence was ‘very low’. There were mixed findings for secondary outcomes. Conclusions: A volume-outcome relationship may exist in certain situations, although this relationship appears to be attenuating with time, and there is ‘very low’ certainty of evidence. While volume might be important, it should not be the only standard used to define an acceptable PCI service and a broader evaluation of quality metrics should be considered that encompass patient experience and clinical outcomes. Systematic review registration: PROSPERO, CRD42019125288

Volume-Outcome Relationship in Surgery for Esophageal malignancy: Systematic Review and Meta-analysis 2000-2011

2011 ◽  
Vol 16 (5) ◽  
pp. 1055-1063 ◽  
Author(s):  
Sheraz R. Markar ◽  
Alan Karthikesalingam ◽  
Sri Thrumurthy ◽  
Donald E. Low
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Outcome Relationship ◽  
Volume Outcome ◽  
Esophageal Malignancy

scholarly journals The volume–outcome relationship for hip fractures: a systematic review and meta-analysis of 2,023,469 patients

2019 ◽  
Vol 90 (1) ◽  
pp. 26-32 ◽  
Author(s):  
Eveline J A Wiegers ◽  
Charlie A Sewalt ◽  
Esmee Venema ◽  
Niels W L Schep ◽  
Jan A N Verhaar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hip Fractures ◽  
Meta Analysis ◽  
Outcome Relationship ◽  
Volume Outcome

scholarly journals Effects of presurgical interventions on chronic pain after total knee replacement: a systematic review and meta-analysis of randomised controlled trials

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e033248 ◽  
Author(s):  
Jane Dennis ◽  
Vikki Wylde ◽  
Rachael Gooberman-Hill ◽  
AW Blom ◽  
Andrew David Beswick
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Moderate Quality ◽  
Total Knee ◽  
Randomised Controlled ◽  
Quality Evidence

ObjectiveNearly 100 000 primary total knee replacements (TKR) are performed in the UK annually. The primary aim of TKR is pain relief, but 10%–34% of patients report chronic pain. The aim of this systematic review was to evaluate the effectiveness of presurgical interventions in preventing chronic pain after TKR.DesignMEDLINE, Embase, CINAHL,The Cochrane Libraryand PsycINFO were searched from inception to December 2018. Screening and data extraction were performed by two authors. Meta-analysis was conducted using a random effects model. Risk of bias was assessed using the Cochrane tool and quality of evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation.Primary and secondary outcomesPain at 6 months or longer; adverse events.InterventionsPresurgical interventions aimed at improving TKR outcomes.ResultsEight randomised controlled trials (RCTs) with data from 960 participants were included. The studies involved nine eligible comparisons. We found moderate-quality evidence of no effect of exercise programmes on chronic pain after TKR, based on a meta-analysis of 6 interventions with 229 participants (standardised mean difference 0.20, 95% CI −0.06 to 0.47, I2=0%). Sensitivity analysis restricted to studies at overall low risk of bias confirmed findings. Another RCT of exercise with no data available for meta-analysis showed no benefit. Studies evaluating combined exercise and education intervention (n=1) and education alone (n=1) suggested similar findings. Adverse event data were reported by most studies, but events were too few to draw conclusions.ConclusionsWe found low to moderate-quality evidence to suggest that neither preoperative exercise, education nor a combination of both is effective in preventing chronic pain after TKR. This review also identified a lack of evaluations of other preoperative interventions, such as multimodal pain management, which may improve long-term pain outcomes after TKR.PROSPERO registration numberCRD42017041382.

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