Provider volume and short term complications after elective total hip replacement: An analysis of Belgian administrative data

The relationship between provider volume and short term complications after an elective total hip replacement was studied on Belgian hospital discharge administrative database from 2004. The analysis included 11 856 patients. Hospitals were classified in low-volume (<= 60/interventions per year), medium volume (61-110) or high volume (> 110). Surgeons were labelled low-volume (<= 6), medium volume (7-20) or high volume (> 20). After adjustment for age, sex, principal diagnosis and comorbidity, surgeon volume was much more predictive of short term complications than centre volume. Patients treated by small volume surgeons (respectively medium volume surgeons) had a 43% higher odds of complications than patients operated by high volume surgeons (respectively 37%). Despite some limitations, Belgian administrative hospital discharge databases can be used to assess the volume outcome relationship for orthopaedic surgery. The study has emphasized the need to closely monitor individual performance, for hospitals and surgeons. Providers requiring further auditing can be effectively identified with funnel plots used routinely in quality control programs.