Impact of centre volume, surgeon volume, surgeon experience and geographic location on reoperation after intramedullary nailing of tibial shaft fractures

Authors

Marc Swiontkowski, University of Minnesota Twin Cities
David Teague, University of Oklahoma Health Sciences Center
Sheila Sprague, McMaster University
Sofia Bzovsky, McMaster University
Diane Heels-Ansdell, McMaster University
Mohit Bhandari, McMaster University
Emil H. Schemitsch, Western University
David W. Sanders, Western University
Paul Tornetta, Boston Medical Center
Stephen D. Walter, McMaster University
Gordon Guyatt
Lisa Buckingham, McMaster University
Pamela Leece, McMaster University
Helena Viveiros, McMaster University
Tashay Mignott, McMaster University
Natalie Ansell, McMaster University
Natalie Sidorkewicz, McMaster University
Julie Agel, University of Minnesota Twin Cities
Claire Bombardier
Jesse A. Berlin
Michael Bosse
Bruce Browner
Peter O'Brien
Rudolf Poolman
Ana Johnson
William Creevy
Mark D. Macleod, Western University
Timothy Carey, Western UniversityFollow
Kellie Leitch, Western University

Document Type

Article

Publication Date

7-1-2021

Journal

Canadian Journal of Surgery

Volume

64

Issue

4

First Page

E371

Last Page

E376

URL with Digital Object Identifier

10.1503/CJS.004020

Abstract

Background: Tibial shaft fractures are the most common long-bone injury, with a reported annual incidence of more than 75 000 in the United States. This study aimed to determine whether patients with tibial fractures managed with intramedullary nails experience a lower rate of reoperation if treated at higher-volume hospitals, or by higher-volume or more experienced surgeons. Methods: The Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) was a multicentre randomized clinical trial comparing reamed and nonreamed intramedullary nailing on rates of reoperation to promote fracture union, treat infection or preserve the limb in patients with open and closed fractures of the tibial shaft. Using data from SPRINT, we quantified centre and surgeon volumes into quintiles. We performed analyses adjusted for type of fracture (open v. closed), type of injury (isolated v. multitrauma), gender and age for the primary outcome of reoperation using multivariable logistic regression. Results: There were no significant differences in the odds of reoperation between high- and low-volume centres (p = 0.9). Overall, surgeon volume significantly affected the odds of reoperation (p = 0.03). The odds of reoperation among patients treated by moderate-volume surgeons were 50% less than those among patients treated by very-low-volume surgeons (odds ratio [OR] 0.50, 95% confidence interval [CI] 0.28-0.88), and the odds of reoperation among patients treated by high-volume surgeons were 47% less than those among patients treated by very-low-volume surgeons (OR 0.53, 95% CI 0.30-0.93). Conclusion: There appears to be no significant additional patient benefit in treatment by a higher-volume centre for intramedullary fixation of tibial shaft fractures. Additional research on the effects of surgical and clinical site volume in tibial shaft fracture management is needed to confirm this finding. The odds of reoperation were higher in patients treated by very-low-volume surgeons; this finding may be used to optimize the results of tibial shaft fracture management.