Increasing Hip Arthroscopy Case Volume Is Associated With Increased Risk for Revision Surgery but Not Conversion to Total Hip Arthroplasty or 90Day Hospitalizations: A Cross-Sectional Analysis of 468 Surgeons

Purpose: To analyze the effects of surgeon -specific factors, including case volume, career duration, fellowship training, practice type, and region of practice, on rates of 2 -year revision surgery, conversion to total hip arthroplasty (THA), and 90 -day hospitalizations following hip arthroscopy. Methods: The PearlDiver Mariner Database was used to query patients undergoing hip arthroscopy between 2015 and 2018. Surgeons performing these procedures were identified, and surgeon -specific demographics and variables were collected from publicly available data. Patients were followed for 2 years to assess for reoperations, including revision hip arthroscopy and conversion to THA, as well as 90 -day hospitalizations, including emergency department visits and hospital readmissions. International Classification of Diseases, Tenth Revision codes were used to track the laterality of revision hip procedures. Associations between surgeon -specific factors and postoperative outcomes were assessed through univariate and multivariate analyses. Results: In total, 20,834 patients underwent hip arthroscopy procedures by 468 surgeons. Multivariate analysis with logistic regression adjusted for patient -related factors (age, sex, obesity, Charlson Comorbidity Index, and smoking status) identified increasing surgeon case volume to be associated with increased risk for 2 -year revision hip arthroscopy (P < .001), but not 2 -year conversion to THA or 90 -day hospitalizations. Nonsports medicine fellowship -trained surgeons were associated with greater risk for 2year THA conversion (P < .001) and 90 -day hospital readmissions (P < .01). Surgeons practicing in an academic setting demonstrated greater risk for 90 -day hospital readmissions (P < .001). Surgeons practicing in the West region of the United States were more likely to incur 2 -year revision hip arthroscopy procedures compared to surgeons in the South, Midwest or Northeast (P < .001). Conclusions: Increasing surgeon hip arthroscopy case volume is associated with an increased risk for 2 -year revision hip arthroscopy but not conversion to THA or 90 -day hospitalizations. Further, nonsports medicine fellowship -trained surgeons were associated with higher risk for 2 -year THA conversion after hip arthroscopy. Level of Evidence: Level III, retrospective cohort analysis.