Surgeon grade has a significant impact on short-term postoperative outcomes in hip fracture surgery


Surgeon grade ; resident ; attending ; operative time ; hip fracture surgery ; education, cannulated screws, total hip arthroplasty, intramedullary nail, hemiarthroplasty

Published online: Oct 08 2021

Hannah Hughes, Gerard Anthony Sheridan, James Storme, Ursula Kelleher, Paul Curtin, Conor Hurson

From the Department of Trauma and Orthopaedic Surgery, St. Vincent’s University Hospital, Dublin, Ireland


Very little is reported on the impact of surgeon grade on hip fracture surgery outcomes. The aim of this study was to investigate the impact of surgeon grade on short-term postoperative outcomes in hip fracture patients.

A Regional Hip Fracture Database (HFD) was ana- lysed over a six-year period. The short-term outcome variables that were assessed included blood loss, postoperative transfusion rates, day-one mobilisation rates, length of stay and the ‘cumulative ambulatory score’. Predictor variables included procedure per- formed, surgeon grade and operative time. The statistical test used was dependent on the variable types. A p-value of less than 0.05 was significant.

In total, 1,593 operative procedures were analysed. The commonest fracture pattern observed was intertrochanteric (n=633, 39.9%). The most common procedures performed were hemiarthroplasty (n= 710) and short intramedullary (IM) nail (n=468). Univariate analysis demonstrated that attending surgeons had significantly lower operative times compared to residents (p<0.05). Shorter operative times and procedures performed by attending surgeons were associated with higher rates of day- one postoperative mobilisation (p<0.05). Shorter operative time and surgeon grade were significant predictors of postoperative transfusion rates (p<0.05). Surgeon grade is an important factor that plays a significant role in determining short-term post- operative outcomes for hip fracture patients. Attending surgeons have shorter operative times, lower rates of postoperative transfusion requirements and higher rates of postoperative day-one mobilisation. We advise that appropriate supervision from experienced attending surgeons is essential to reduce operative times and optimise outcomes for hip fracture patients.