Association between surgeon experience, level of supervision, and outcomes after hip fracture.
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Goh En Lin, Ee Png May, Metcalfe David, Achten Juul, Appelbe Duncan, Griffin Xavier L, Cook Jonathan A, Costa Matthew L, WHiTE Investigators, Goh En Lin, Png May Ee, Metcalfe David, Achten Juul, Appelbe Duncan, Griffin Xavier L, Cook Jonathan A, Costa Matthew L, Barrett Michael, Hull Peter, Melling David, Kosy Jonathan, Charalambous Charalambous P, Keast-Butler Oliver, Magill Paul, Yarlagadda Rathan, Vashista Girish, Savaridas Terence, Sturridge Seb, Smith Graham, Dasari Kishore, Bhaskar Deepu, Bajada Stefan, Bigsby Ewan, Mahmood Ansar, Dunbar Mark, Jimenez Andrea, Wood Ryan, Penny James, Eardley William, Handley Robert, Srinivasan Suresh, Gee Matt, Kulkarni Ashwin, Davison John, Maqsood Mohammad, Sharma Amit, Peach Chris, Sheeraz Ahsan, Page Piers, Kelly Andrew, McNamara Iain, Longstaff Lee, Reed Mike, Moppett Iain, Sorial Ayman, Joachim Theophilus, Ng Aaron, Gallagher Kieran, Farrar Mark, Ghande Ad, Bird Jonathan, Rajagopalan Shyam, McAndrew Andrew, Sloan Andrew, Middleton Rory, Remedios Ian Dos, McClelland Damian, Rogers Benedict, Berstock James, Bhatnagar Sharad, Diamond Owen, Fearon Paul, Gill Inder, Dunlop Doug, Chesser Tim, Acharya Mehool, Sree Deepak, Craik Johnathan, Hutchinson David, Johnson David, Elgalli Mosab, Dixon Paul, Ellapparadja Pregash, Slater Guy, Kozdryk Jakub, Young Jonathan, Ben Ollivere Khitish Mohanty, Faisal Mohammad, Clark Callum, Dhinsa Baljinder, Malek Ibrahim, Heaton Sam, Blocker Oliver, Theivendran Kanthan
Аннотация
METHODS: A multicentre, prospective cohort study of patients aged 60 years and older with a hip fracture in the UK. Primary exposure was operating surgeon grade and level of supervision. Outcomes were health-related quality of life (HRQoL; EuroQol five-dimension five-level questionnaire (EQ-5D-5L)), mortality, and complications at four months. Linear and Cox proportional hazards regression models were fitted to assess the relationship between operating surgeon grade and level of supervision, and HRQoL, mortality, and complications.
RESULTS: Among 24,523 patients with a hip fracture, there were 12,702 consultant-performed and 11,365 resident-performed operations. Operations performed by supervised residents had better recovery of EQ-5D-5L (mean difference (MD) 0.02, 95% CI 0.01 to 0.03; p < 0.001), a similar risk of mortality (HR 0.92, 95% CI 0.84 to 1.01; p = 0.083), but higher risks of reoperation (HR 1.29, 95% CI 1.06 to 1.57; p = 0.009), blood transfusion (HR 1.44, 95% CI 1.28 to 1.62; p < 0.001), acute kidney injury (HR 1.72, 95% CI 1.46 to 2.04; p < 0.001), lower respiratory tract infection (HR 1.22, 95% CI 1.10 to 1.35; p < 0.001), cerebrovascular accident (HR 1.98, 95% CI 1.33 to 2.95, p < 0.001), and myocardial infarction (HR 1.91, 95% CI 1.33 to 2.74; p < 0.001), compared with operations performed by consultants. Operations performed by unsupervised residents had better recovery of EQ-5D-5L (MD 0.02, 95% CI 0.00 to 0.03; p = 0.008), a similar risk of mortality (HR 0.92, 95% CI 0.81 to 1.06; p = 0.260), but a higher risk of blood transfusion (HR 1.54, 95% CI 1.33 to 1.80; p < 0.001) compared with operations performed by consultants.
CONCLUSION: Operations performed by residents were associated with a better recovery of QoL, similar mortality, but slightly more complications compared with consultants. This highlights the need for tailored supervision and structured training to optimize outcomes and ensure patient safety.