PDF(Pubmed)
Abstract：
UNASSIGNED: Given the complexity of arthroscopic rotator cuff repair (ARCR) and increasing prevalence, there is a need for comprehensive, large-scale studies that investigate potential correlations between surgeon-specific factors and postoperative outcomes after ARCR. This study examines how surgeon-specific factors including case volume, career length, fellowship training, practice setting, and regional practice impact two-year reoperation rates, conversion to total shoulder arthroplasty (anatomic or reverse), and 90-day post-ARCR hospitalization.
UNASSIGNED: The PearlDiver Mariner database was used to collect surgeon-specific variables and query patients who underwent ARCR from 2015 to 2018. Patient outcomes were tracked for two years, including reoperations, hospitalizations, and International Classification of Diseases, Tenth Revision codes for revision rotator cuff repair (RCR) laterality. Hospitalizations were defined as any emergency department (ED) visit or hospital readmission within 90 days after primary ARCR. Surgeon-specific factors including surgeon case volume, career length, fellowship training, practice setting, and regional practice were analyzed in relation to postoperative outcomes using both univariate and multivariate logistic regression.
UNASSIGNED: 94,150 patients underwent ARCR by 1489 surgeons. On multivariate analysis, high-volume surgeons demonstrated a higher risk for two-year total reoperation (odds ratio [OR] = 1.06, 95% confidence interval [CI]: 1.01-1.12, P = .03) and revision RCR (OR = 1.06, 95% CI: 1.01-1.12, P = .02) compared to low-volume surgeons. Early-career surgeons showed higher rates of 90-day ED visits (mid-career surgeons: OR = 0.78, 95% CI: 0.73-0.83, P < .001; late-career surgeons: OR = 0.73, 95% CI: 0.68-0.78, P < .001) and hospital readmission (mid-career surgeons: OR = 0.74, 95% CI: 0.63-0.87, P < .001; late-career surgeons: OR = 0.73, 95% CI: 0.61-0.88, P = .006) compared to mid- and late-career surgeons. Sports medicine and/or shoulder and elbow fellowship-trained surgeons demonstrated lower two-year reoperation risk (OR = 0.95, CI: 0.91-0.99, P = .04) and fewer 90-day ED visits (OR = 0.93, 95% CI = 0.88-0.98, P = .002). Academic surgeons experienced higher readmission rates compared to community surgeons (OR = 1.16, 95% CI = 1.01-1.34, P = .03). Surgeons practicing in the Northeast demonstrated lower two-year reoperation (OR = 0.88, 95% CI: 0.83-0.93, P < .001) and revision (OR = 0.88, 95% CI: 0.83-0.94, P < .001) RCR risk compared to surgeons in the Southern United States.
UNASSIGNED: High-volume surgeons exhibit higher two-year reoperation rates after ARCR compared to low-volume surgeons. Early-career surgeons demonstrate increased hospitalizations. Sports medicine or shoulder and elbow surgery fellowships correlate with reduced two-year reoperation rates and 90-day ED visits.
UNASSIGNED: The PearlDiver Mariner database was used to collect surgeon-specific variables and query patients who underwent ARCR from 2015 to 2018. Patient outcomes were tracked for two years, including reoperations, hospitalizations, and International Classification of Diseases, Tenth Revision codes for revision rotator cuff repair (RCR) laterality. Hospitalizations were defined as any emergency department (ED) visit or hospital readmission within 90 days after primary ARCR. Surgeon-specific factors including surgeon case volume, career length, fellowship training, practice setting, and regional practice were analyzed in relation to postoperative outcomes using both univariate and multivariate logistic regression.
UNASSIGNED: 94,150 patients underwent ARCR by 1489 surgeons. On multivariate analysis, high-volume surgeons demonstrated a higher risk for two-year total reoperation (odds ratio [OR] = 1.06, 95% confidence interval [CI]: 1.01-1.12, P = .03) and revision RCR (OR = 1.06, 95% CI: 1.01-1.12, P = .02) compared to low-volume surgeons. Early-career surgeons showed higher rates of 90-day ED visits (mid-career surgeons: OR = 0.78, 95% CI: 0.73-0.83, P < .001; late-career surgeons: OR = 0.73, 95% CI: 0.68-0.78, P < .001) and hospital readmission (mid-career surgeons: OR = 0.74, 95% CI: 0.63-0.87, P < .001; late-career surgeons: OR = 0.73, 95% CI: 0.61-0.88, P = .006) compared to mid- and late-career surgeons. Sports medicine and/or shoulder and elbow fellowship-trained surgeons demonstrated lower two-year reoperation risk (OR = 0.95, CI: 0.91-0.99, P = .04) and fewer 90-day ED visits (OR = 0.93, 95% CI = 0.88-0.98, P = .002). Academic surgeons experienced higher readmission rates compared to community surgeons (OR = 1.16, 95% CI = 1.01-1.34, P = .03). Surgeons practicing in the Northeast demonstrated lower two-year reoperation (OR = 0.88, 95% CI: 0.83-0.93, P < .001) and revision (OR = 0.88, 95% CI: 0.83-0.94, P < .001) RCR risk compared to surgeons in the Southern United States.
UNASSIGNED: High-volume surgeons exhibit higher two-year reoperation rates after ARCR compared to low-volume surgeons. Early-career surgeons demonstrate increased hospitalizations. Sports medicine or shoulder and elbow surgery fellowships correlate with reduced two-year reoperation rates and 90-day ED visits.
摘要：
■鉴于关节镜肩袖修复（ARCR）的复杂性和患病率的增加，有必要全面，大型研究调查外科医生特异性因素与ARCR术后结局之间的潜在相关性。本研究调查了外科医生的特定因素，包括病例体积，职业长度,奖学金培训，练习设置,和区域实践影响两年的再手术率，转换为全肩关节置换术（解剖或反向），和ARCR住院后90天。
■PearlDiverMariner数据库用于收集外科医生特定的变量，并查询2015年至2018年接受ARCR的患者。对患者的预后进行了两年的跟踪，包括重新操作，住院治疗,和国际疾病分类，第十次修订肩袖修补术（RCR）侧向性的修订代码。住院定义为初次ARCR后90天内的任何急诊科（ED）就诊或再次入院。外科医生特定因素，包括外科医生病例量，职业长度,奖学金培训，练习设置,使用单变量和多变量逻辑回归分析和区域实践与术后结局的关系。
■94,150名患者接受了1489名外科医生的ARCR。在多变量分析中，与低容量外科医生相比,高容量外科医生2年总再手术风险较高(比值比[OR]=1.06,95%置信区间[CI]:1.01~1.12,P=.03)和修正RCR(OR=1.06,95%CI:1.01~1.12,P=.02).职业生涯早期外科医生的90天ED访视率较高（职业生涯中期外科医生：OR=0.78，95％CI：0.73-0.83，P<.001；职业生涯后期外科医生：OR=0.73，95％CI：0.68-0.78，P<.001）和医院再入院（职业生涯中期外科医生：OR=0.74，95％CI：0.63-0.87，职业生涯后期外科医生：0.73，运动医学和/或肩肘研究员培训的外科医生显示出两年再手术风险较低（OR=0.95，CI：0.91-0.99，P=.04）和90天ED访视次数较少（OR=0.93，95％CI=0.88-0.98，P=.002）。与社区外科医生相比，学术外科医生的再入院率更高（OR=1.16，95％CI=1.01-1.34，P=0.03）。与美国南部的外科医生相比，在东北部执业的外科医生显示出更低的两年再手术风险（OR=0.88，95％CI：0.83-0.93，P<.001）和修订（OR=0.88，95％CI：0.83-0.94，P<.001）。
与小批量外科医生相比，大批量外科医生在ARCR后表现出更高的两年再手术率。职业生涯早期的外科医生显示住院率增加。运动医学或肩部和肘部外科手术研究金与减少的两年再手术率和90天的ED访视相关。
■PearlDiverMariner数据库用于收集外科医生特定的变量，并查询2015年至2018年接受ARCR的患者。对患者的预后进行了两年的跟踪，包括重新操作，住院治疗,和国际疾病分类，第十次修订肩袖修补术（RCR）侧向性的修订代码。住院定义为初次ARCR后90天内的任何急诊科（ED）就诊或再次入院。外科医生特定因素，包括外科医生病例量，职业长度,奖学金培训，练习设置,使用单变量和多变量逻辑回归分析和区域实践与术后结局的关系。
■94,150名患者接受了1489名外科医生的ARCR。在多变量分析中，与低容量外科医生相比,高容量外科医生2年总再手术风险较高(比值比[OR]=1.06,95%置信区间[CI]:1.01~1.12,P=.03)和修正RCR(OR=1.06,95%CI:1.01~1.12,P=.02).职业生涯早期外科医生的90天ED访视率较高（职业生涯中期外科医生：OR=0.78，95％CI：0.73-0.83，P<.001；职业生涯后期外科医生：OR=0.73，95％CI：0.68-0.78，P<.001）和医院再入院（职业生涯中期外科医生：OR=0.74，95％CI：0.63-0.87，职业生涯后期外科医生：0.73，运动医学和/或肩肘研究员培训的外科医生显示出两年再手术风险较低（OR=0.95，CI：0.91-0.99，P=.04）和90天ED访视次数较少（OR=0.93，95％CI=0.88-0.98，P=.002）。与社区外科医生相比，学术外科医生的再入院率更高（OR=1.16，95％CI=1.01-1.34，P=0.03）。与美国南部的外科医生相比，在东北部执业的外科医生显示出更低的两年再手术风险（OR=0.88，95％CI：0.83-0.93，P<.001）和修订（OR=0.88，95％CI：0.83-0.94，P<.001）。
与小批量外科医生相比，大批量外科医生在ARCR后表现出更高的两年再手术率。职业生涯早期的外科医生显示住院率增加。运动医学或肩部和肘部外科手术研究金与减少的两年再手术率和90天的ED访视相关。
