Low-Volume and Early-Career Surgeons Have Higher Risk for Reoperation and Complications Following Anterior Cruciate Ligament Reconstruction

Aidan J Foley; Ryan T Halvorson; Cameron Nosrat; Brandon R Ho; Ashraf N Nawari; Kirk Terada-Herzer; Brian T Feeley; Drew A Lansdown; C Benjamin Ma; Alan L Zhang

doi:10.1016/j.arthro.2024.10.017

Low-Volume and Early-Career Surgeons Have Higher Risk for Reoperation and Complications Following Anterior Cruciate Ligament Reconstruction

Arthroscopy. 2024 Oct 28:S0749-8063(24)00801-6. doi: 10.1016/j.arthro.2024.10.017. Online ahead of print.

Affiliations

¹ University of California, San Francisco, School of Medicine, San Francisco, California, U.S.A.
² Department of Orthopaedic Surgery, University of California, San Francisco, California, U.S.A.
³ Department of Orthopaedic Surgery, University of California, San Francisco, California, U.S.A.. Electronic address: Alan.Zhang@ucsf.edu.

PMID: 39476879
DOI: 10.1016/j.arthro.2024.10.017

Abstract

Purpose: To characterize the population of surgeons performing anterior cruciate ligament reconstructions (ACLRs) in the United States and investigate the relationships between surgeon volume, career duration, and practice setting on surgical outcomes.

Methods: A large nationwide insurance database was queried for patients undergoing primary ACLR. Provider gender, degree type (allopathic vs osteopathic), practice setting (academic vs private as defined by ACGME affiliation), surgeon volume per year, and career duration were obtained. Reoperations, hospitalizations, and emergency department visits were recorded. The relationships between surgeon-specific factors and postoperative outcomes were investigated through univariable and multivariable analyses controlling for patient factors such as age, gender, and comorbidities.

Results: 54,498 patients underwent ACLR by 3,782 surgeons between 2015 and 2019 with a minimum 2-year follow-up. 97.2% of the surgeons were male, and 90.9% had an allopathic degree. Multivariate analysis controlling for patient variables, including age, gender, and comorbidities revealed surgeons with low yearly ACLR case volume demonstrated higher risk for revision ACLR, while surgeons with high yearly case volume had lower revision ACLR rates (P = .02, P =.003). Additionally, low-case volume per year had higher rates of emergency department visits (P = .01). Early career surgeons had higher rates of both ACLR and non-ACLR arthroscopic reoperations (P < .001, P = .006), as well as increased emergency department visits (P < .001). Academic affiliation was independently associated with greater non-ACLR reoperations (P < .001), emergency department visits (P = .007), and hospital readmissions (.006).

Conclusions: Patients undergoing ACLR by early career surgeons and surgeons with low yearly ACLR case volume were at increased risk for revision ACLR and postoperative ED visits.

Level of evidence: Level III, Retrospective cohort study.