Volume versus outcomes in orthopaedic surgery: A proper perspective is paramount

Volume versus outcomes. How should the orthopaedic surgeon and the medical community at large react? This issue of The Journal contains an important article by Katz et al. dealing with the association between hospital and surgeon volume and outcomes of total hip surgery in the United States Medicare population. It appears logical to assume that the more experience that a surgeon has with a particular procedure, the better the result and that a so-called learning curve may be associated with many surgical procedures. One can hardly argue with the goal of improving our care of patients by providing the best possible outcome. This is particularly true of high-volume procedures such as total hip replacements, which are performed at the rate of more than 200,000 per year. The majority of both primary and revision total hip arthroplasties in patients in the Medicare population are performed by surgeons who carry out fewer than ten of these procedures per year. Higher surgeon and/or hospital volume has been associated with better outcomes in several areas, including cardiac surgery; cancer surgery; cataract surgery; and medical management of various conditions, including myocardial infarction. There have been similar reports involving orthopaedic procedures, including total knee and total hip arthroplasty.