gms | German Medical Science

The mortality rates of many surgical procedures are inversely related to hospital and surgeon procedure volume. Currently there is a discussion regarding the implementation of high volume centers for total knee replacement. The American National Cancer Policy Board came up with four evidence criteria describing a valid association between volume and outcome: 1) the association must be logical, 2) the association must be consistent, 3) the size of the measured effect must be substantial and has to be analyzed using statistical criteria and 4) the effect has to be reproducable.

We searched MEDLINE (1985 until July 2004) for full articles that reported on an association between procedure volume and outcome after total knee replacement.

We found nine relevant studies in MEDLINE. The outcome after primary knee prosthesis and revision knee prosthesis was better when performed in high volume hospitals or by high volume surgeons. Yet, many of the included studies were of minor quality. Perioperative mortality was the main outcome

described in most of the studies, the more useful data on long term survival of the prosthesis remained unmentioned. There were wide variations in the definition of „high volume" and „low volume". All trials were conducted in english speaking countries and are not directly transferable to our medical system in Germany.

Applying the criteria designed by the American National Cancer Policy Board on the studies about procedure volume and outcome after total knee replacement yields the following result: 1) Yes. 2) Yes. 3) No. 4) No.