Jain and colleagues examined whether the yearly shoulder arthroplasty caseload of a surgeon or hospital is related to inhospital outcomes of TSA and hemiarthroplasty.
Retrospective cohort from the Nationwide Inpatient Sample, 1988 to 2000: 12,594 TSAs and 17,452 hemiarthroplasties. Level III.
Higher‑volume surgeons and hospitals would have lower mortality, fewer complications, shorter stays and more patients discharged home.
Key Findings
TSA in hospitals doing fewer than 5 a year had more inhospital complications than in hospitals doing 10 or more (1.44% vs 0.64%, adjusted OR 2.5, 95% CI 1.5 to 4.2).
Hospitals doing 5 to 9 TSAs a year also had more complications than high‑volume hospitals (OR 2.1, 95% CI 1.2 to 3.6). Surgeon volume was not significantly linked to TSA complications.
After hemiarthroplasty, patients of surgeons doing fewer than 2 a year had more complications than those of surgeons doing 5 or more (1.68% vs 0.97%, OR 2.2, 95% CI 1.1 to 4.4). Hospital volume showed no such link.
TSA mortality was 0.36% for surgeons doing fewer than 2 a year vs 0.20% for 4 or more (OR 4.4, 95% CI 0.6 to 31.2), not statistically significant because so few patients died.
TSA patients of surgeons doing 5 or more a year went home 17 hours earlier than those of surgeons doing fewer than 2. Adjusted TSA stay was 3.3 days in hospitals doing 10 or more vs 4.1 days in hospitals doing fewer than 5 (both significant).
Surgeon identifiers were missing for 41.3% of TSAs and 45.5% of hemiarthroplasties, and the data held no severity grading, post‑discharge complications or functional outcomes.
Authors' conclusion
Patients who have a total shoulder arthroplasty or hemiarthroplasty performed by a high-volume surgeon or in a high-volume hospital are more likely to have a better outcome.
Jain and colleagues examined whether the yearly shoulder arthroplasty caseload of a surgeon or hospital is related to inhospital outcomes of TSA and hemiarthroplasty.
Retrospective cohort from the Nationwide Inpatient Sample, 1988 to 2000: 12,594 TSAs and 17,452 hemiarthroplasties. Level III.
Higher‑volume surgeons and hospitals would have lower mortality, fewer complications, shorter stays and more patients discharged home.
Key Findings
TSA in hospitals doing fewer than 5 a year had more inhospital complications than in hospitals doing 10 or more (1.44% vs 0.64%, adjusted OR 2.5, 95% CI 1.5 to 4.2).
Hospitals doing 5 to 9 TSAs a year also had more complications than high‑volume hospitals (OR 2.1, 95% CI 1.2 to 3.6). Surgeon volume was not significantly linked to TSA complications.
After hemiarthroplasty, patients of surgeons doing fewer than 2 a year had more complications than those of surgeons doing 5 or more (1.68% vs 0.97%, OR 2.2, 95% CI 1.1 to 4.4). Hospital volume showed no such link.
TSA mortality was 0.36% for surgeons doing fewer than 2 a year vs 0.20% for 4 or more (OR 4.4, 95% CI 0.6 to 31.2), not statistically significant because so few patients died.
TSA patients of surgeons doing 5 or more a year went home 17 hours earlier than those of surgeons doing fewer than 2. Adjusted TSA stay was 3.3 days in hospitals doing 10 or more vs 4.1 days in hospitals doing fewer than 5 (both significant).
Surgeon identifiers were missing for 41.3% of TSAs and 45.5% of hemiarthroplasties, and the data held no severity grading, post‑discharge complications or functional outcomes.
Authors' conclusion
Patients who have a total shoulder arthroplasty or hemiarthroplasty performed by a high-volume surgeon or in a high-volume hospital are more likely to have a better outcome.