Shoulder & Elbow Clinical PaperThe effect of surgeon and hospital volume on shoulder arthroplasty perioperative quality metrics
Section snippets
Selection of the study cohort
In 2007, Institutional Review Board approval was obtained to commence prospective data collection for a multicenter institutional Shoulder Arthroplasty Registry within a large integrated health care system that serves more than 5 million individuals. Fifteen percent of members are older than 60 years, a good approximation of the U.S. population. A retrospective cohort study was performed with data including demographic information, comorbidities, ICD-9 codes, implant data, surgical metrics, and
Demographics
The average age for RSA (74.9 years [±7.67]) was significantly older than the average age for TSA (69.1 years [±8.93]) or HA (65.9 [±11.8]) (P < .001). The proportion of genders was comparable across procedure groups, with men representing 49.1% of TSA cases, 50.9% of HA cases, and 42% of RSA cases (P = .14). Body mass index within 90 days of surgery was lower in RSA, 28.4 (±5.62), compared with TSA 30.3 (±5.89) and HA 30.0 (±6.17) (P < .005). The demographic results are summarized in Table I.
Discussion
Many studies demonstrate an inverse relationship between surgeon or hospital volume and mortality rates, functional status, and complications from a variety of procedures,3 including aneurysm repair,8 cataract surgery,2 coronary artery bypass graft,31 thyroidectomy,34 carotid endarterectomy,27 and lung cancer resection.1
Several studies in the orthopaedic literature have examined the relationship between provider and institutional volume and objective outcomes such as mortality, readmission,
Conclusion
This study demonstrates that on average, high-volume surgeons and hospitals performed shoulder HA, TSA, and RSA with less blood loss, lower surgical time, and shorter length of stay compared with lower volume practitioners and hospitals.
Disclaimer
The authors, their immediate families, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.
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The Kaiser Permanente Institutional Review board approved the study with IRB #5527 on July 20, 2012.