Evaluating the learning curve associated with fixation of proximal femoral fractures: A systematic review.

Abstract

To systematically evaluate the learning curve associated with surgical fixation of proximal femoral fractures and to assess its impact on operative efficiency, complication rates, and reoperation outcomes during surgical training. Systematic review. Studies were drawn from institutional and academic surgical centers reporting outcomes of proximal femur fracture fixation; included studies represented tertiary care and teaching hospital environments. A comprehensive search of PubMed and Embase (Elsevier) identified English-language studies published through August 2023 reporting learning curve metrics in surgical fixation of proximal femur or peritrochanteric fractures. Review articles and case reports were excluded. A total of 22 studies encompassing 42,537 patients met inclusion criteria. Operating room time was the most studied metric, with 9 of 15 studies reporting significantly longer operative durations in the presence of residents or when surgeries were performed by less experienced surgeons. Similarly, 4 of 5 studies on fluoroscopy duration reported significantly longer fluoroscopy usage times or increased total radiation dose in less experienced surgeons. Most studies investigating reoperation and complication rates did not report significant differences between residents and less experienced surgeons compared to their more experienced colleagues. Most studies demonstrated a consistent inverse correlation between operating room time and fluoroscopy usage with surgeon experience, reflecting progressive technical efficiency with training. However, the early training phase among less experienced residents does not appear to compromise patient safety, as reoperation and complication rates show no significant association with surgeon experience. To more accurately assess and facilitate surgical competency, residency programs should incorporate feedback metrics across a variety of case complexity and the standardized definitions of intraoperative supervision into their evaluation frameworks. Level III.