Einfluss der Weiterbildung auf Komplikationsdichte und Kosten einer H�ftendoprothese

Abstract

We studied the effect of surgical experience with regard to complications and costs after 3290 primary total hip arthroplasties (diagnosis: osteoarthritis). We retrospectively analysed duration of clinical treatment and anaesthesia, blood loss, number of banked blood and perioperative complications (fractures of the shaft and acetabulum, dislocations, peripheral nerve injuries, thrombosis of the deep veins, embolism and deep wound infections) related to the experience of the surgeon (junior surgeons in comparison to the consultant) after 3290 primary THA's from 1974 to 1997. Cost analysis was performed by measurement of time and material expenditure. 39.2% of all operations were performed by junior surgeons. This number emphasizes the realisation of the order of education in our clinic. Both groups showed just few differences in number of duration of clinical treatment, banked blood, nerve leasions and embolism. We found statistically not significant increased rates of fractures and dislocations in the THA's performed by an unexperienced surgeon, however the rates decreased the last 14 years. Significantly higher rates of deep wound infection at the beginning decreased in the last 9 years to the level of experienced surgeons. Due to longer operation times, we calculated higher expenses of DM 85 per case in the group of junior surgeons. Using an educational program, carried out with an experienced surgeon, there is nearly no additional risk for the patient regarding the complication rates in THA's. However, there are higher financial expenses that have to be calculated.