Incidence and Complications of Open Hip Preservation Surgery: An American Board of Orthopaedic Surgery Database Review

Transcription

1 Incidence and Complications of Open Hip Preservation Surgery: An American Board of Orthopaedic Surgery Database Review Jon P Hedgecock MD, 1 P Christopher Cook MD FRCS(C), 1 John Harrast PhD,2 Judith F Baumhauer MD, 1 Brian D. Giordano MD1 1University of Rochester Medical Center, Rochester, NY 2American Board of Orthopaedic Surgeons, Hinsdale, Il

2 Disclosures Giordano BD: Consultant, research support, royalties Arthrex Inc. All other authors have no disclosures to report

3 Introduction Hip preservation surgery (HPS) encompasses a multitude of techniques, both arthroscopic and open, aimed at restoring joint congruity and function of the hip There has been a significant growth in interest in arthroscopic HPS The purpose of this study was to assess the trends and complications of candidates for the American Board of Orthopaedic Surgery (ABOS) Part II examination performing procedures related to open HPS We hypothesized that open hip preservation surgery would show a similar increase in incidence, with complications remaining constant over time

4 Methods The ABOS database for all initial Part II applicants was queried for all open HPS related CPT codes (summarized in table 1) from for patients age > 10 Age, sex, incidence, complications, fellowship training background, and geographic location were noted Data was analyzed by linear regression analysis using Microsoft Excel, with statistical significance set at p = 0.05

5 Results CPT codes Description of CPT Total Number of complications Osteotomy and transfer of greater trochanter of femur Percent complications Osteotomy, iliac, acetabular or innominate bone Osteotomy, iliac, acetabular or innominate bone with open reduction of hip Osteotomy, iliac, acetabular or innominate bone, with femoral osteotomy Osteotomy, iliac, acetabular or innominate bone, with femoral osteotomy and with open reduction of hip Osteotomy, pelvis, bilateral Osteotomy, femoral neck (separate procedure) Osteotomy, intertrochanteric or subtrochanteric Open treatment of slipped femoral epiphysis; osteoplasty of femoral neck (Heyman type procedure) Open treatment of slipped femoral epiphysis; osteotomy and internal fixation Number of CPT codes 730 Number of total cases 644 Table 1: CPT codes queried, total number reported CPT codes, total number of complications per CPT code, and percent complications per CPT code.

6 Number of Cases/CPT codes Results Cases and CPT codes per year Cases per year CPT codes per year Year Figure 1: Data per year for total cases and CPT codes. Linear regression coefficient for the case trend line is (p = 0.18) and (p = 0.09) for CPT codes.

7 Number of Complications Results 35 Complications per year Year Figure 2: Total complications per year. Linear regression coefficient for the trend line is (p = 0.13). There were 212 total complications.

8 Number of Cases Results Geographic location of applicants Northeast 20 Southeast South 15 Southwest Northwest 10 Midwest Other Year Figure 3: Geographic location of applicants over time. There was a statistically significant increase in surgeries performed in the midwest (R 2 = 0.639, p =.003)

9 Results Fellowships Candidates Pediatric Orthopaedics 134 Adult Reconstruction 77 Trauma 57 Sports Medicine 30 Oncology 18 Other 55 Table 2: Fellowship training background Individual complications (212 total): Medical Unspecified: 28, Bone Fracture: 23, Surgical Unspecified: 23, Infection: 18, Skin ulcer/blister: 15, Wound Dehiscence: 14, Non Union/Delayed Union: 11, Nerve Palsy/Injury: 10, Dislocation: 9, Hemorrhage: 8, Implant Failure: 8, Pneumonia: 6, Surgical Procedure Intervention: 5, Renal Failure: 4, Patient Expired: 4, Anesthetic Complication: 3, Implant Fracture: 3, Compartment Syndrome: 2, Pulmonary Embolism: 2, Congestive Heart Failure: 2, Urinary retention: 2, Anemia: 2, Limb Ischemia: 1, Myocardial Infarction: 1, Cerebral Vascular Accident: 1, Implant failure/fracture/malfunction: 1, Wound healing delay/failure: 1, Loss of reduction: 1, RSD/CRPS: 1, Urinary tract infection: 1, Hypotension: 1, Dermatologic complaint: 1.

10 Discussion The incidence and complications of open HPS in candidates for ABOS Part II examination remained relatively constant during the study period The incidence and complications of open HPS in novice surgeons should continue at a predictable rate into the future. It is unclear if the increase in arthroscopic HPS has led to the undertreatment of patients with significant bony deformity Further study would be useful to compare this data for candidates applying for recertification

11 Acknowledgments We would like to acknowledge and thank the American Board of Orthopaedic Surgery for providing data used for this study. It also should be noted that the study does not reflect the specific views of the ABOS.

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