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  • Relationship between hospital or surgeon volume and outcomes in joint arthroplasty: protocol for a suite of systematic reviews and dose–response meta-analyses

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Surgery
Protocol
Relationship between hospital or surgeon volume and outcomes in joint arthroplasty: protocol for a suite of systematic reviews and dose–response meta-analyses
  1. Xiang-Dong Wu1,2,
  2. Meng-Meng Liu3,
  3. Ya-Ying Sun4,
  4. Zhi-Hu Zhao5,
  5. Quan Zhou6,
  6. Joey S W Kwong7,8,
  7. Wei Xu1,
  8. Mian Tian1,9,
  9. Yao He1,10,
  10. Wei Huang1
  1. 1 Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
  2. 2 Evidence-Based Perioperative Medicine 07 Collaboration Group, China
  3. 3 Department of Pathology, Anhui Medical University, Hefei, China
  4. 4 Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
  5. 5 Department of orthopaedic, Tianjin Hospital, Tianjin, China
  6. 6 Department of Science and Education, First People’s Hospital of Changde City, Changde, China
  7. 7 Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
  8. 8 Department of Clinical Epidemiology, National Center for Child Health and Development, Tokyo, Japan
  9. 9 Department of Orthopaedic Surgery, Dianjiang People’s Hospital, Chongqing, China
  10. 10 Department of Orthopaedic Surgery, Banan People’s Hospital of Chongqing, Chongqing, China
  1. Correspondence to Dr Xiang-Dong Wu; xiangdong_wu{at}outlook.com,xiangdong_wu{at}foxmail.com and Professor Wei Huang; drhuangwei68{at}gmail.com,huangwei68{at}263.net

Abstract

Introduction Joint arthroplasty is a particularly complex orthopaedic surgical procedure performed on joints, including the hip, knee, shoulder, ankle, elbow, wrist and even digit joints. Increasing evidence from volume–outcomes research supports the finding that patients undergoing joint arthroplasty in high-volume hospitals or by high-volume surgeons achieve better outcomes, and minimum case load requirements have been established in some areas. However, the relationships between hospital/surgeon volume and outcomes in patients undergoing arthroplasty are not fully understood. Furthermore, whether elective arthroplasty should be restricted to high-volume hospitals or surgeons remains in dispute, and little is known regarding where the thresholds should be set for different types of joint arthroplasties.

Methods and analyses This is a protocol for a suite of systematic reviews and dose–response meta-analyses, which will be amended and updated in conjunction with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Electronic databases, including PubMed and Embase, will be searched for observational studies examining the relationship between the hospital or surgeon volume and clinical outcomes in adult patients undergoing primary or revision of joint arthroplasty. We will use records management software for study selection and a predefined standardised file for data extraction and management. Quality will be assessed using the Newcastle-Ottawa Scale, and the meta-analysis, subgroup analysis and sensitivity analysis will be performed using Stata statistical software. Once the volume–outcome relationships are established, we will examine the potential non-linear relationships between hospital/surgeon volume and outcomes and detect whether thresholds or turning points exist.

Ethics and dissemination Ethical approval is not required, because these studies are based on aggregated published data. The results of this suite of systematic reviews and meta-analyses will be submitted to peer-reviewed journals for publication.

PROSPERO registration number CRD42017056639.

  • arthroplasty
  • hospital volume
  • surgeon volume
  • volume-outcome relationship
  • threshold

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-022797

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    Footnotes

    • Contributors X-DW and WH conceived and designed the study. X-DW drafted the protocol. M-ML, Y-YS, Z-HZ, QZ, JSWK, WX, MT, YH and WH revised the protocol. X-DW and Y-YS will search for and select eligible studies. Z-HZ and MT will extract the data, M-ML will check the data. YH and WX will assess the risk of bias. QZ and JSWK will perform the data synthesis. X-DW and WH act as guarantors of the protocol. All authors approved the publication of the protocol.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Because this suite of systematic reviews and dose–response meta-analyses involves analysis of anonymous secondary data that are available in the public domain, and does not involve human participants or encroach on the privacy of individual patients, ethical approval is not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.