Surgeon Experience in Determining Clinical and Economic Outcomes for Shoulder Arthroplasty

Authors: JW Hammond et al.

References: Presented at AAOS 2003

Abstract
The objective of this study was to determine whether increased surgeon experience was associated with improved clinical and economic outcomes for patients undergoing total shoulder arthroplasty and hemiarthroplasty procedures. We analyzed discharge data from 1994 to 2000 from a statewide hospital discharge database of all patients in the state of Maryland undergoing total shoulder arthroplasty and hemiarthroplasty. We assessed the relationship of surgeon volume (low, medium, and high) to the risk of complications, hospital duration, and total charges. Statistics were adjusted for procedure, age, gender, race, marital status, co-morbidity, diagnosis, insurance, income, and hospital volume. Of the 1,868 discrete total shoulder arthroplasties and hemiarthroplasties done in the state of Maryland, the risk of at least one complication in the high-volume surgeon group was nearly half that of low-volume surgeons (adjusted odds ratio [OR], 0.6; 95% confidence interval [CI], 0.4-0.9). High-volume surgeons were three times more likely than low-volume surgeons to have patients with a hospital stay of less than 6 days (OR, 0.3; 95% CI, 0.2-0.6). The average cost of hospitalization between the two groups was not statistically significant after adjustment (OR, 0.8; 95% CI, 0.5-1.4). This study indicates that surgeons with higher average annual caseloads of total shoulder arthroplasty and hemiarthroplasty procedures have decreased complication rates and hospital duration. These analyses of hospital discharge data are limited due to lack of prospective data, operative details, and patient satisfaction scores. However, this study emphasizes the importance of continued education and diligence of health care providers when performing shoulder arthroplasty.