The risk of revision surgery after trainee-led primary total hip replacement

TL;DR

This study found no overall difference in mortality or revision rates between trainee-led and consultant-led hip replacement surgeries, but unsupervised trainee surgeries had higher early revision risks.

Contribution

The study provides evidence on the safety of trainee-led hip replacements and highlights risks associated with unsupervised procedures.

Findings

No difference in one-year mortality between trainee-led and consultant-led surgeries.

Unsupervised trainee surgeries had a higher risk of early revision in the latest study period.

Overall, no significant temporal changes in outcomes were observed over the 15-year period.

Abstract

The aim of this study was to determine the impact of operating surgeon grade and level of supervision on the incidence of one-year patient mortality and all-cause revision following elective primary total hip replacement (THR).

National Joint Registry data from 2005 to 2020 for a single University Teaching Hospital were used, with analysis performed on the 15-year dataset divided into 5-year block periods (B1, 2005–2010; B2, 2010–2015; B3, 2015–2020). Outcome measures were mortality and revision surgery at one year, in relation to lead surgeon grade, and level of supervision for trainee-led (TL) operations.

A total of 9,999 eligible primary THRs were performed, of which 5,526 (55.3%) were consultant-led (CL), and 4,473 (44.7%) TL. Of TL, 2,404 (53.7%) were nonconsultant-supervised (TU) and 2,069 (46.3%) consultant-supervised (TS). The incidence of one-year patient mortality was 2.05% (n=205), and all-cause revision was 1.11% (n=111). There was no difference in one-year mortality between TL and CL operations (p=0.20, odds ratio (OR) 0.78, confidence interval (CI) 0.55–1.10). The incidence of one-year revision was not different for TL and CL operations (p=0.15, OR 1.37, CI 0.89–2.09). Overall, there was no temporal change for either outcome measure between TL or CL operations. A significant increase in revision within one-year was observed in B3 between TU compared with CL operations (p=0.005, OR 2.81, CI 1.35–5.87).

We found no difference in overall one-year mortality or all-cause revision rate between TL and CL primary THR. Despite a reduction in unsupervised THR in the latest five-year period (2015–2020), unsupervised TL THR resulted in an increased risk of early revision.

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