BACKGROUND A shift in the healthcare system towards the centralization of common yet costly surgeries, such as total hip arthroplasty (THA), to high-volume centers of excellence, is an attempt to control the economic burden while simultaneously enhancing patient outcomes. The "volume-outcome" relationship suggests that hospitals performing more treatment of a given type exhibit better outcomes than hospitals performing fewer. This theory has surfaced as an important factor in determining patient outcomes following THA. We performed a systematic review with meta-analyses to review the available evidence on the impact of hospital volume on outcomes of THA. MATERIALS AND METHODS We conducted a review of PubMed (MEDLINE), OVID MEDLINE, Google Scholar, and Cochrane library of studies reporting the impact of hospital volume on THA. The studies were evaluated as per the inclusion and exclusion criteria. A total of 44 studies were included in the review. We accessed pooled data using random-effect meta-analysis. RESULTS Results of the meta-analyses show that low-volume hospitals were associated with a higher rate of surgical site infections (1.25 [1.01, 1.55]), longer length of stay (RR, 0.83[0.48-1.18]), increased cost of surgery (3.44, [2.57, 4.30]), 90-day complications (RR, 1.80[1.50-2.17]) and 30-day (RR, 2.33[1.27-4.28]), 90-day (RR, 1.26[1.05-1.51]), and 1-year mortality rates (RR, 2.26[1.32-3.88]) when compared to high-volume hospitals following THA. Except for two prospective studies, all were retrospective observational studies. CONCLUSIONS These findings demonstrate superior outcomes following THA in high-volume hospitals. Together with the reduced cost of the surgical procedure, fewer complications may contribute to saving considerable opportunity costs annually. However, a need to define objective volume-thresholds with stronger evidence would be required. TRIAL REGISTRATION PROSPERO CRD42019123776.

中文翻译：

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医院容量对全髋关节置换术结果的影响：系统评价和荟萃分析。

背景技术医疗保健系统转向将常见但昂贵的手术（例如全髋关节置换术（THA））集中到大容量的卓越中心，是控制经济负担同时提高患者治疗效果的一种尝试。“数量-结果”关系表明，对特定类型进行更多治疗的医院比进行较少治疗的医院表现出更好的结果。该理论已成为决定全髋关节置换术后患者预后的重要因素。我们通过荟萃分析进行了系统回顾，以回顾关于医院容量对 THA 结局影响的现有证据。材料和方法 我们对 PubMed (MEDLINE)、OVID MEDLINE、Google Scholar 和 Cochrane 研究库进行了回顾，报告了医院容量对 THA 的影响。根据纳入和排除标准对研究进行评估。该评价总共纳入了 44 项研究。我们使用随机效应荟萃分析来访问汇总数据。结果 荟萃分析结果显示，医院容量较小的医院与手术部位感染率较高（1.25 [1.01，1.55]）、住院时间较长（RR，0.83[0.48-1.18]）、手术费用增加相关。手术 (3.44, [2.57, 4.30])、90 天并发症 (RR, 1.80[1.50-2.17]) 和 30 天 (RR, 2.33[1.27-4.28])、90 天 (RR, 1.26[1.05- 1.51]）和 1 年死亡率（RR，2.26[1.32-3.88]）与接受 THA 的大容量医院相比。除两项前瞻性研究外，其余均为回顾性观察研究。结论 这些研究结果表明，在大容量医院中进行 THA 后可获得优异的结果。加上手术成本的降低，并发症的减少可能有助于每年节省大量的机会成本。然而，需要用更有力的证据来定义客观的数量阈值。试用注册 PROSPERO CRD42019123776。