After Primary Total Shoulder Arthroplasty, Factors Associated with Returning to the Same Surgeon for Subsequent Total Shoulder Arthroplasty.

Abstract

Background: Total shoulder arthroplasty (TSA) is commonly done for degenerative conditions. Patients may need additional contralateral TSA or ipsilateral revision TSA. As a marker of patient satisfaction and practice integrity, factors associated with return to the same or different surgeon are of interest.

Methods: Patients undergoing TSA were abstracted from the PearlDiver data set. Subsequent TSA within 2 years was identified. Factors analyzed included age, sex, comorbidity burden, prior depression diagnosis, insurance type, reverse versus anatomic TSA, ipsilateral versus contralateral surgery, and postoperative adverse events. Patients returning to the same surgeon versus different surgeon were compared with multivariable analysis.

Results: 98,048 TSA patients were identified, with 8483 patients (8.7%) undergoing subsequent TSA within 2 years. Of those, 1,237 (14.6%) chose a different surgeon. Factors associated with changing surgeons were revision surgery on the ipsilateral shoulder (OR:2.47), Medicaid insurance (OR:1.46), female sex (OR:1.36), any adverse events (OR:1.23), and higher Elixhauser Comorbidity Index (OR:1.07 per point), while prior depression diagnosis was associated with decreased odds (OR:0.74) of changing surgeon (P < 0.05 for all).

Discussion: When pursuing a subsequent TSA, only a minority of patients changed to a different surgeon. Factors identified associated with changing to a different surgeon may help guide measures to improve patient satisfaction and practice integrity.