Table 2 from retrospective database analyses (joints and carpal tunnel)
From: Minimum volume standards in day surgery: a systematic review
| Â | Degen et al. [10] (2017) | Evers et al. [11] (2018) | Jain et al. [12] (2005) | Jain et al. [13] (2004) | Liu et al. [14] (2018) |
|---|---|---|---|---|---|
Country | USA | The Netherlands | USA | USA | USA |
Sponsor | National Institute of Health/ National Institute for Arthritis and Musculoskeletal and Skin Diseases (R01AR066069) | National Institute of Health/ National Institute of Arthritis and Musculoskeletal and Skin Diseases (RO1 AR82813) | NA | NA | NA |
COI | 1 author (B.T.K) has COI due to fees form Arthrex and A-3 surgical | None | NA | NA | None |
Study design | Retrospective database analysis of 137 surgical centres (multivariate regression) | Retrospective database analysis of 11 surgical centres (univariate and multivariate regression) | Retrospective database analysis of unclear number of surgical centres (univariate and multivariate regression) | Retrospective database analysis of unclear number of surgical centres (multivariate logistic and linear regression) | Retrospective database analysis of unclear number of surgical centres (multivariate regression) |
Conducted in | 1998–2012 | 2011–2015 | 1997–2000 | 1997–2000 | 2009–2013 |
Indication | Hip arthroscopy | Carpal tunnel syndrome | See inclusion criteria below | See inclusion criteria below | Anterior cruciate ligament injury |
Intervention | Primary hip arthroscopy | Open carpal tunnel releases | Rotator cuff repair | ACL reconstruction & Meniscectomy | ACL reconstruction |
Setting | Outpatient | Outpatient | Outpatient | Outpatient | Outpatient |
Type of volume analysis (surgeon/hospital) | Surgeon | Surgeon | Surgeon & hospital | Surgeon & hospital | Hospital |
Comparator | NA | NA | NA | NA | NA |
Number of pts | 7836 | 2057a | 10,934b | ACL: 32,440 Men: 195,597c | 26,873 |
Number of procedures | 8267d | 2057 | NA | NA | NA |
Number of surgeons | 295 | 17 | NA | NA | NA |
Number of hospitals | 137 | 11 | NA | NA | NA |
Surgeon volume categories, n (cases/year) | Â | Â | ACL/Men: | Â | |
 β Low | < 102 | 6–44 | < 15e | < 25f/< 75 | NA |
 β Medium | 102 ≤ x < 164 | 47–71 | 15 ≤ x < 30 | 25 ≤ x < 75/75 ≤ x < 175 |  |
 β High | 164 ≤ x < 340 | 75–163 | ≥30 | ≥75/≥175 |  |
 β Very high | ≥340 | NA | NA | NA |  |
Hospital volume categories, n (cases/year) | Â | Â | ACL/Men: | Â | |
 β Low | NA | NA | < 75 | < 125/< 600g | < 1006 |
 β Medium | NA | NA | ≥75- < 200 | 125 ≤ x < 300/600 ≤ x < 1200 | ≥100- < 500 |
 β High | NA | NA | ≥200 | ≥300/≥1200 | ≥500 |
Operating time, median in min (range) | NA | NA | 102 (30–595)h | ACL: 125 (NA) Men: 55 (NA) | NA |
Inclusion criteria | HA for diagnosis with or without synoval biopsy, HA for removal of loose/foreign body, HR & chondroplasty, abrasion arthroplasty & resection of labrum, HA & synovectomy, HA with femoroplasty, HA with acetabuloplasty, HA with labral repair, total hip replacement, resurfacing hip & partial/total acetabulum & femoral head | Consent, primary carpal tunnel release, baseline and follow-up measurement of BCTQ | Rupture of the rotator cuff, disorders of bursae and tendon, sprains and strains of the rotator cuff capsule | ACL: Complete rupture of old disruption of ACL and sprain of cruciate ligament of the knee Men: derangement, bucket handle tear, simple tear of the meniscus or cartilage | NA |
Exclusion criteria | NA | Unavailable operative report, unidentified surgeon, cases in which surgeons did not perform CTRs for at least 1 year within the cohort | Shoulder bone infection, present surgery as corrective surgery, malignancy, pathologic fracture, fracture due to injury in the bones of the shoulder region, or simultaneous total or partial shoulder arthroplasty | ACL/Men: Lower leg bone infections like osteomyelitis, inflammatory reaction due to graft, correction surgery, malignancies or pathological fractures, fractures due to injury, simultaneous knee arthroplasty, rheumatoid arthritis, operating time < 45 min & < 20 min in case of meniscectomy | Non-New York residents, pts. that left against medical advice, mortalities, pts. < 18 yrs., surgeries from December 2013 |
Co-interventions | NA | Trigger finger release, cubital tunnel relese, Guyon release, radial tunnel release, fasciotomy Dupuytren, other, standard postoperative care – nerve and tendon-gliding exercises | NA | NA | NA |
Age, mean, yrs (range) | 38 (7–84) | 54 (41–67) | 56 (43.6–68.4) | ACL: 29.4 (18.9–39.9) Men: 47.3 (31.9–62.7) | Average 33.3 (22.0–46.6) |
Sex, female:male, n | 4443:3801 | 986:359 | 3785-6188 | ACL: 7481: 10,908i Men: 50,108:72,889j | 9811:17,049 |
BMI ± SD | NA | 27 ± 5 | NA | NA | NA |
Comorbidities | NA | Diabetes mellitus, Rheumatoid arthritis, Dupuytren’s disease, Trigger fingers, CMCI joint arthritis, compression neuropathy, tendinitis, history of wrist trauma, scaphotrapeziotrapezoidal joint arthritis, radiocarpal arthritis, peripheral neuropathy, cervical radioculopathy, ulnocarpal impingement | Mean Deyo score: 0.1–0.9 | NA | Mean Deyo score: 0.06 |
Follow-up time, yrs | 10k | 0.5 | NA | NA | 30 days |
Patients excluded from the analysis, n (%) | ? | 712 | 961 | ACL: 14,050 Men: 72,585 | NA |
Efficacy | |||||
 Survival, % | At 2/5/10 yrs |  |  |  |  |
 β Low | 86.5/78.5/72.7 | NA | NA | NA | NA |
 β Medium | 87.8/82.7/82.7 |  |  |  |  |
 β High | 94.6/90.2/90.2 |  |  |  |  |
 β Very high | 97.6/97.6/97.6 |  |  |  |  |
Reduction in pain score units on VAS scale, baseline/6 mo by volume, mean n (SD) | |||||
 β Low | NA | Low: 47/18l | NA | NA | NA |
 β Medium |  | Medium: 51/20 |  |  |  |
 β High |  | High: 51/19 |  |  |  |
 β P value |  | NA |  |  |  |
BCTQ, mean n | |||||
 β Symptom severity score | NA | Low&Medium&High: all 1.7m | NA | NA | NA |
 β Functional status score | NA | Low&Medium&High: all 1.7 | NA | NA | NA |
Hospital based acute care within 30 days, odds ratio n at 5 years (p value) | |||||
 β Low volume | NA | NA | NA | NA | x |
 β Medium volume | NA | NA | NA | NA | 0.77 (p 0.059) |
 β High volume | NA | NA | NA | NA | 0.47 (p < 0.001) |
Risk of reoperation, hazard ratio n (95% CI) | |||||
 β Low volume | x |  |  |  |  |
 β Medium volume | 0.9x (CI-0.74) | NA | NA | NA | NA |
 β High volume | 0.42 (CI 0.32) | NA | NA | NA | NA |
 β Very high volume | 0.17 (CI 0.07) | NA | NA | NA | NA |
Nonroutine disposition of pts at dischargen, surgeon, n (95% CI) | |||||
 β Low volume | NA | NA | 2.8x (0.9–9.1) | ACL: 0.9% Men: 1.4% | NA |
 β Medium volume | NA | NA | 1.5x (0.7–3.1) | ACL: 0.4% Men: 0.7% | NA |
 β High volume | NA | NA | x | ACL: 0.2% Men: 0.5% | NA |
Nonroutine disposition of pts at discharge, hospital, n (95% CI) | |||||
 β Low volume | NA | NA | 2.1x (0.6–8.0) | ACL: 1% Men: 1.6% | NA |
 β Medium volume | NA | NA | 1.7x (0.2–11.6) | ACL: 0.2% Men: 1.2% | NA |
 β High volume | NA | NA | x | ACL: 0.3% Men: 0.2% | NA |
Mean operating time volume, surgeon, min (±SD) | |||||
 β Low volume | NA | NA | 112 (4) | ACL: 149(9) Men: 72(6)o | NA |
 β Medium volume | NA | NA | 113 (4) | ACL: 137(9) Men: 64(6) | NA |
 β High volume | NA | NA | 102 (4) | ACL: 122(9) Men: 53(6) | NA |
 β p value | NA | NA | < 0.001 | NA | NA |
Mean operating time volume, hospital, min (±SD) | |||||
 β Low volume | NA | NA | 111 | ACL: 150(9) Men: 71(5)15 | NA |
 β Medium volume | NA | NA | 109 | ACL: 132(9) Men: 66(6) | NA |
 β High volume | NA | NA | 105 | ACL: 129(14) Men: 52(6) | NA |
LOS and surgeon volume, n (95% CI) | |||||
 β Low volume | NA | NA | 2.3x (1.2–4.4) | NA | NA |
 β Medium volume | NA | NA | 1.3x (0.7–2.6) | NA | NA |
 β High volume | NA | NA | x | NA | NA |
LOS and hospital volume, n (95% CI) | |||||
 β Low volume | NA | NA | 0.5x (0.2–1.1) | NA | NA |
 β Medium volume | NA | NA | 1.1x (0.4–3.1) | NA | NA |
 β High volume | NA | NA | x | NA | NA |
Safety | |||||
 SAE | NA | NA | NA | NA | NA |
 AEs, n (%) | NA (0.2)p | 23 (1.6) | NA | NA | Unclearq |
β Day surgery related AEs | MI, ileus, pneumonia, sepsis, mechanical complication, hardware failure, DVT/PE, wound infection, dislocation/iatrogenic instability, major bleedr | Wound infection, wound dehiscence | NA | NA | NA |