Background and purpose — It has been hypothesized that hospitals and surgeons with high caseloads of hip fracture patients have better outcomes, but empirical studies have reported contradictory results. This systematic review and meta-analysis evaluates the volume–outcome relationship among patients with hip fracture patients. Methods — A search of different databases was performed up to February 2018. Selection of relevant studies, data extraction, and critical appraisal of the methodological quality was performed by 2 independent reviewers. A random-effects meta-analysis using studies with comparative cut-offs was performed to estimate the effect of hospital and surgeon volume on outcome, defined as in-hospital mortality and postoperative complications. Results — 24 studies comprising 2,023,469 patients were included. Overall, the quality was reasonable. 11 studies reported better health outcomes in high-volume centers and 2 studies reported better health outcomes in low-volume centers. In the meta-analysis of 11 studies there was a statistically non-significant association between higher hospital volume and both lower in-hospital mortality (adjusted odds ratio (aOR) 0.87, 95% confidence interval (CI) 0.73–1.04) and fewer postoperative complications (aOR 0.87, CI 0.75– 1.02). Four studies on surgeon volume were included in the meta-analysis and showed a minor association between higher surgeon volume and in-hospital mortality (aOR 0.92, CI 0.76–1.12). Interpretation — This systematic review and metaanalysis did not find an evident effect of hospital or surgeon volume on health outcomes. Future research without volume cut-offs is needed to examine whether a true volume–outcome relationship exists.

Additional Metadata
Persistent URL dx.doi.org/10.1080/17453674.2018.1545383, hdl.handle.net/1765/115194
Journal Acta Orthopaedica (Print)
Citation
Wiegers-Groeneweg, E.J.A, Sewalt, C.A., Venema, E, Schep, N.W.L, Verhaar, J.A.N, Lingsma, H.F, & den Hartog, D. (2019). The volume-outcome relationship for hip fractures: a systematic review and meta-analysis of 2,023,469 patients. Acta Orthopaedica (Print), 90(1), 26–32. doi:10.1080/17453674.2018.1545383