The Relationship Between Surgeon Volume and Major Surgical Complications After Total Shoulder Arthroplasty: An Evaluation of 3177 US Orthopedic Surgeons.

IF 1.1 4区 医学 Q3 ORTHOPEDICS Orthopedics Pub Date : 2024-10-31 DOI:10.3928/01477447-20241028-03
Kevin C Liu, Cory K Mayfield, Mary K Richardson, Ioanna K Bolia, Jacob L Kotlier, Nathanael D Heckmann, Seth C Gamradt, Alexander E Weber, Joseph N Liu, Frank A Petrigliano
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Abstract

Background: Total shoulder arthroplasty (TSA), which includes anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA), is a technically demanding procedure and limited data exist on the relationship between case volume and complications. We sought to identify volume thresholds for TSA, aTSA, and rTSA at which risk of a major surgical complication decreased and to compare complications of patients treated by high-volume surgeons with those of patients treated by low-volume surgeons.

Materials and methods: Primary, elective TSAs (aTSA and rTSA) from January 1, 2016, to December 31, 2019, were identified in the Premier Healthcare Database. Multivariable logistic regression with restricted cubic splines modeled the relationship between annual TSA, aTSA, and rTSA surgeon volume and 90-day risk of major surgical complications. The 90-day complications of patients treated by high- and low-volume surgeons were compared.

Results: From 2016 to 2019, 3177 surgeons performed 78,639 TSAs. Increasing annual volume was associated with decreasing major surgical complication risk (thresholds: 50 TSAs, 25 aTSAs, and 36 rTSAs). High- and low-volume surgeons performed 24,595 and 54,044 TSAs, respectively. Patients of high-volume surgeons had lower risk of major surgical complications (adjusted odds ratio [aOR], 0.69; 95% CI, 0.56-0.84), myocardial infarction (aOR, 0.59; 95% CI, 0.36-0.97), and readmission (aOR, 0.71; 95% CI, 0.62-0.81). Importantly, 74.9% of high-volume and 93.0% of low-volume surgeon-year units had major surgical complication rates below the mean of all recorded surgeons.

Conclusion: While most high- and low-volume surgeons had major surgical complication rates below the cohort average, increasing TSA volume was associated with a decreased risk of complications. [Orthopedics. 202x;4x(x):xx-xx.].

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外科医生数量与全肩关节置换术后主要手术并发症之间的关系:对 3177 名美国骨科医生的评估。
背景:全肩关节置换术(TSA)包括解剖型全肩关节置换术(aTSA)和反向全肩关节置换术(rTSA),是一种技术要求很高的手术,有关病例量与并发症之间关系的数据有限。我们试图确定TSA、aTSA和rTSA的手术量阈值,在此阈值下发生重大手术并发症的风险会降低,并比较由手术量大的外科医生和手术量小的外科医生治疗的患者的并发症情况:在Premier医疗数据库中确定了2016年1月1日至2019年12月31日期间的初级、择期TSA(aTSA和rTSA)。使用受限立方样条的多变量逻辑回归模拟了年度TSA、aTSA和rTSA外科医生数量与90天主要手术并发症风险之间的关系。比较了高手术量和低手术量外科医生治疗患者的 90 天并发症:从2016年到2019年,共有3177名外科医生实施了78639例TSA手术。年手术量的增加与主要手术并发症风险的降低有关(阈值:50例TSA、25例aTSA和36例rTSA)。高产量和低产量外科医生分别进行了 24,595 例和 54,044 例 TSA。高手术量外科医生的患者发生主要手术并发症(调整后几率比 [aOR],0.69;95% CI,0.56-0.84)、心肌梗死(aOR,0.59;95% CI,0.36-0.97)和再入院(aOR,0.71;95% CI,0.62-0.81)的风险较低。重要的是,74.9%的高手术量单位和93.0%的低手术量单位的主要手术并发症发生率低于所有记录在案的外科医生的平均水平:结论:虽然大多数高手术量和低手术量外科医生的主要手术并发症发生率都低于队列平均水平,但TSA手术量的增加与并发症风险的降低有关。[骨科。202x;4x(x):xx-xx]。
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来源期刊
Orthopedics
Orthopedics 医学-整形外科
CiteScore
2.20
自引率
0.00%
发文量
160
审稿时长
3 months
期刊介绍: For over 40 years, Orthopedics, a bimonthly peer-reviewed journal, has been the preferred choice of orthopedic surgeons for clinically relevant information on all aspects of adult and pediatric orthopedic surgery and treatment. Edited by Robert D''Ambrosia, MD, Chairman of the Department of Orthopedics at the University of Colorado, Denver, and former President of the American Academy of Orthopaedic Surgeons, as well as an Editorial Board of over 100 international orthopedists, Orthopedics is the source to turn to for guidance in your practice. The journal offers access to current articles, as well as several years of archived content. Highlights also include Blue Ribbon articles published full text in print and online, as well as Tips & Techniques posted with every issue.
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