背景:已证明外科医生体积的增加与骨科手术后结果的改善相关。然而,缺乏数据证明外科医生容量对全肩关节置换术后结局的影响.
方法:回顾性查询了2010-2022年的PearlDiverMariner数据库。使用CPT代码23472(全肩关节成形术)选择接受肩关节成形术的患者。40岁以下的患者,接受翻修关节成形术和双侧关节成形术的患者被排除.此外,有骨折史的病例,感染,或手术前的恶性肿瘤被排除在外.仅选择至少进行10例手术的外科医生,并使用其提供者ID代码查询PearlDiver。主要结果指标包括90天,1年,以及2年的并发症和再手术率。使用Bonferroni校正,其中显著性阈值设置为p≤0.00082。结果:共有155,560名患者符合纳入标准,并保留用于分析。在研究期间,外科医生体积的第90百分位数确定为112例。高于第90百分位数(n=340)的外科医生对68,531名患者进行手术,而低于第90百分位数(n=3,038)的外科医生对87,029名患者进行手术。高容量组的外科医生更有可能完成肩肘研究金(p<0.001),而在肩肘或运动医学之外没有研究金培训或研究金培训的可能性较小(p<0.001)。低容量外科医生对基线合并症较高的患者进行手术(CCI:2.01vs1.85,p<0.001)。在调整了年龄之后,性别,CCI,肥胖,和烟草的使用,高容量的外科医生经历了较低的医疗并发症,包括肾功能衰竭(p<0.001),贫血(p<0.001),和UTI(p<0.001)。所有原因再入院(0.90,p<0.001),在大批量外科医生中,90天再次手术(OR0.75,p<0.001)和1年再次手术(OR:0.86,p<0.001)显著较低.大量外科医生表现出各种并发症的发生率较低,包括人工关节感染(90d:p<0.001;1yr:p<0.001;2yr:p<0.001),假体周围骨折(90d:p<0.001;1yr:p<0.001;2yr:p<0.001)和所有并发症(90d:p<0.001;1yr:p<0.001)。
结论:进行大量全肩关节置换术的外科医生比进行少量肩关节置换术的外科医生更有可能对更健康的患者进行手术。与小批量外科医生相比,在调整了年龄之后,性别,和CCI,高容量外科医生的总体并发症发生率显著较低.尽管并发症发生率较低,自2016年以来,大量外科医生对肩关节置换术的比例有所下降.
BACKGROUND: Increased surgeon
volume has been demonstrated to correlate with improved outcomes after orthopedic surgery. However, there is a lack of data demonstrating the effect of surgeon
volume on outcomes after total shoulder arthroplasty.
METHODS: The PearlDiver Mariner database was retrospectively queried from the years 2010-2022. Patients undergoing shoulder arthroplasty were selected using the CPT code 23472 (Total Shoulder Arthroplasty). Patients under 40 years of age, those undergoing revision arthroplasty and cases of bilateral arthroplasty were excluded. Additionally, cases with a history of fracture, infection, or malignancy prior to surgery were excluded. Only surgeons who performed a minimum of 10 cases were selected and PearlDiver was queried using their provider ID codes. Primary outcome measures included 90 day, 1-year, and 2-year rates of complication and reoperation. A Bonferroni correction was utilized in which the significance threshold was set at p≤0.00082 RESULTS: A total of 155,560 patients met inclusion criteria and were retained for analysis. The 90th percentile for surgeon
volume was determined to be 112 cases during the study period. Surgeons above the 90th percentile (n=340) operated on 68,531 patients whereas surgeons below the 90th percentile (n=3,038) operated on 87,029 patients. Surgeons in the high-volume group were significantly more likely to have completed a Shoulder and Elbow fellowship (p<0.001) and less likely to have no fellowship training or fellowship training outside of Shoulder and Elbow or Sports Medicine (p<0.001). Low-volume surgeons operated on patients with higher baseline comorbidities (CCI: 2.01 vs 1.85, p<0.001). After adjusting for age, gender, CCI, obesity, and tobacco use, high-volume surgeons experienced lower rates of medical complications including renal failure (p<0.001), anemia (p<0.001), and UTI (p<0.001). All cause readmission (0.90, p<0.001), reoperation at 90 days (OR 0.75, p<0.001) and reoperation at 1 year (OR: 0.86, p<0.001) were significantly lower among high-volume surgeons. High-volume surgeons exhibited lower rates of various complications including prosthetic joint infection (90d: p<0.001; 1yr: p<0.001; 2yr: p<0.001), periprosthetic fracture (90d: p<0.001; 1yr: p<0.001; 2yr: p<0.001) and all complications (90d: p<0.001; 1yr: p<0.001).
CONCLUSIONS: Surgeons who perform a high volume of total shoulder arthroplasty are more likely to operate on healthier patients than surgeons who perform a lower
volume of cases. When compared to low-
volume surgeons, and after adjusting for age, gender, and CCI, high-
volume surgeons have a significantly lower overall complication rate. Despite this lower complication rate, high-volume surgeons are responsible for a decreasing portion of shoulder arthroplasty since 2016.