Impact of surgeon experience on patient outcomes after pelvic and acetabular fracture surgery

TL;DR

The study found that surgeon experience significantly reduces complications and improves surgical efficiency in treating complex pelvic and acetabular fractures.

Contribution

This study provides empirical evidence on how surgeon experience impacts short-term outcomes in complex orthopedic trauma surgeries.

Findings

Complication rates dropped from 16.7% in the first year to 4.5% after the first year of practice.

Operative time decreased significantly from 271.5 minutes in the first year to 185.1 minutes in years 2-7.

Estimated blood loss decreased significantly in the first two years of practice but remained high overall.

Abstract

Emerging data suggests present day surgeons coming out of training are treating fewer pelvic and acetabular injuries in practice than their predecessors. Few studies have investigated the acute effects of this in the perioperative setting, despite the critical condition of many of these patients. Accordingly, there is a need now for studies that examine how surgeon experience affects short-term outcomes in this patient population.

This is a retrospective cohort performed at a level I trauma center at UCSF- Fresno. Patients who underwent operative fixation for pelvic and/or acetabular fractures treated by a single fellowship-trained orthopaedic trauma surgeon year 1 through year 7 in practice were included. Electronic medical records were retrospectively reviewed for data collection. Yearly time points for surgeon experience were defined and compared. The primary outcome was acute surgical complications within six weeks. Secondary outcome measurements were estimated blood loss (EBL), operative time, transfusion requirements, and unplanned re-operation.

Two hundred and six patients met study criteria. There was a significant difference in complications during year 1 versus after year 1: 16.7% and 4.5%, respectively (p = 0.026), and between years 1–2 and after year 2, 13.3% and 3.4%, respectively, (p = 0.022). There was no difference in complications after 2 years. Average operative time in the first year was 271.5 minutes, whereas average operative time for years 2-7 was 185.1 minutes (p=0.016). This difference remained significant until after year 4. There was a significant difference in estimated blood loss (EBL) between post-training years 0-2 and years 2+: 505.5 mL and 263.6 mL, respectively (p = 0.039). There was a significance difference in EBL between years 0-3 versus years 3+. There was no statistically significant difference after this. There was no difference in transfusions received or unplanned re-operations at all time points.

There was no difference in complications at most time points. Despite statistically significant decreases in operative times and blood loss over the first five years in practice, pelvis and acetabular surgeries were shown to have significant blood loss and surgical time regardless of experience. Furthermore, there were no differences in transfusions and unplanned re-operations at all time points, suggesting that fellowship-trained surgeons in high-volume centers can safely treat these complex procedures without a clinically significant increase in morbidity early in their careers.