Operative duration-based learning period analysis for reverse and total shoulder arthroplasty: A multicenter study

Testa, Edward J; Lowe, Jeremiah T.; Namdari, Surena; Gillespie, Robert J.; Sears, Benjamin W.; Johnston, Peter S.; Jawa, Andrew

doi:10.1177/1758573218811635

Cited by 6 publications

(24 citation statements)

References 39 publications

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“…2 In an analysis of several fellowship-trained arthroplasty surgeons, Testa et al reported that recent fellowship graduates performing TSA at high volumes demonstrate an initial steep learning curve, followed by a substantial decrease in operative times after up to 86 cases. 16 This trend, in the context of our results, may be apparent in surgeons at a population level and is one element contributing to the decrease in TSA surgical duration over time. Moreover, the advances in implant technology and technique are readily apparent over the past decade and may contribute to improved operative speed by improving surgical efficiency and eliminating unnecessary surgical steps.…”

Section: Discussionsupporting

confidence: 57%

Trends in operative duration of total shoulder arthroplasty from 2008 to 2018: a national database study

Testa

Lemme

et al. 2021

Shoulder & Elbow

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Background As total shoulder arthroplasty has emerged as the fastest growing joint replacement performed, optimizing surgical efficiency and patient outcomes is essential. The goals of the current study were to identify trends and factors affecting the operative time of total shoulder arthroplasty over a 10-year period. Methods The National Surgical Quality Improvement Program database was analyzed to determine the operative time and 30-day complications of total shoulder arthroplasty from 2008 to 2018. Factors affecting total shoulder arthroplasty operative time were also assessed. Multivariable linear regression was used to analyze operative time over years studied while controlling for patient demographics and comorbidities. Results A total of 20,587 total shoulder arthroplasty cases from 2008 to 2018 were included. Mean operative time in 2008 was 139.0 min, while in 2018, mean operative time decreased to 105.6 min (P < .001). Male sex, outpatient surgery, increased body mass index, and low preoperative hematocrit were associated with longer operative times, while elevated international normalized ratio, resident involvement, and elective surgeries were associated with decreased operative duration. Discussion Operative time for total shoulder arthroplasty has decreased from 2008 to 2018. Patient factors and comorbidities are associated with operative time, and such factors are important to consider in operative planning to ensure appropriate patient and surgeon expectations.

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Section: Discussionsupporting

confidence: 57%

Trends in operative duration of total shoulder arthroplasty from 2008 to 2018: a national database study

Testa

Lemme

et al. 2021

Shoulder & Elbow

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“…In our series, operative times remained consistent throughout the study period and averaged 89 min for our first 10 cases and 83 min for our subsequent 11 cases. Operative time has been infrequently reported in prior TT series, however, prior shoulder arthroplasty studies have indicated decreases in operative times with increased case volumes [ 10 , 25 ]. In contrast to our findings, Testa et al found that higher case volumes decreased operative times for shoulder arthroplasty [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Operative time has been infrequently reported in prior TT series, however, prior shoulder arthroplasty studies have indicated decreases in operative times with increased case volumes [ 10 , 25 ]. In contrast to our findings, Testa et al found that higher case volumes decreased operative times for shoulder arthroplasty [ 10 ]. Outside of upper-extremity surgery, Konan et al noted that operative times decreased by 46% after their first 10 hip arthroscopy cases in a single surgeon investigation [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…Prior investigations have aimed to analyze practice patterns of early career upper-extremity surgeons as well as assess surgical complications for surgeons within their board collection period [ 7 - 8 ]. Studies involving shoulder arthroplasty procedures performed by early career surgeons have demonstrated decreased operative times, lower complication rates, and overall decreases in healthcare costs as surgeons gain more experience [ 9 - 10 ]. While these investigations suggest there may be a “learning curve” associated with some procedures, prior studies assessing elbow arthroscopy suggest that a complication-based learning curve may not exist [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Learning Curve Associated With Operative Treatment of Terrible Triad Elbow Fracture Dislocations

Ozdag¹,

Luciani²,

Delma³

et al. 2022

Cureus

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Purpose: To assess the outcomes of operatively treated terrible triad (TT) elbow injuries for a single surgeon at the start of clinical practice. We aimed to define postoperative patient reported outcome measures (PROMs), range of motion (ROM), and complications during the period immediately following fellowship training, in order to describe the learning process for surgical treatment of TT.Methods: All operatively treated TTs from 2017 to 2020 were included. All cases were performed by a single, fellowship-trained upper-extremity surgeon and represented a consecutive series at the start of clinical practice. Baseline demographics, injury characteristics, and surgical details were recorded for each case. PROMs [QuickDisability of arm, shoulder, and hand (DASH) and (visual analog scale) pain scale], ROM, and complications were recorded at the time of final follow-up. A perioperative glucocorticoid protocol was used in all cases without diabetes.Results: There was a total of 21 included TT cases with a mean follow-up of 20 months. The operative time averaged 89 min for the first 10 cases and 83 min for the subsequent 11 cases. The mean QuickDASH and VAS pain score at final follow-up were 19 and 2.3, respectively. The mean flexion-extension arc was 122° and two cases (9%) had < 100° arc of motion. The mean pronation-supination arc was 145°. Three cases (14%) had a postoperative complication, all of which underwent reoperation. Of the 21 included cases, these reoperations represented cases #1, #14, and #17 respectively. Conclusions: Upper-extremity surgeons at the start of clinical practice may be able to achieve outcomes similar to more experienced surgeons for operatively treated TT elbow fracture dislocations. There does not appear to be a substantial "learning curve" after fellowship training with respect to PROMs, complication rates, or operative time associated with surgical treatment of TT elbow injuries.

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“…All complications in the ABOS Part II Oral Examination database are self-reported, and therefore require a candidate's honesty to ensure accuracy. Complication data may not be appropriate for extrapolation to all surgeons as surgical learning curves in early-career surgeons have been described, 27 and all cases included in this study are from the first 18 months of a surgeon's independent career. The complication rates (particularly in relation to long-term complications) may also be limited by the short follow-up period (mean, 8.5 wk; range, 0 to 49 wk) inherent to the structure of the ABOS Part II Oral Examination candidate case logs.…”

Section: Discussionmentioning

confidence: 99%

Trends in Operative Treatment of Pediatric and Adolescent Forearm Fractures Among American Board of Orthopaedic Surgery Part II Candidates

Testa

Pérez

Tran

et al. 2021

Journal of Pediatric Orthopaedics

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Background: Pediatric and adolescent forearm fractures are among the most common injuries treated by orthopaedic surgeons. Recent literature shows that there has been an increased interest in operative management for these injuries. The purpose of the current study was to examine the trends in case volume, patient age, surgeon fellowship training, and postoperative complications of surgically treated pediatric forearm fractures over > 15-year period of American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination candidates. Methods: ABOS Part II candidates' Oral Examination Case List data from 2003 to 2019 was queried for all pediatric and adolescent (19 y of age and below) forearm fractures treated operatively. Patient demographics, fracture type, complications, and candidate fellowship type were identified for each case. Linear regression was used to delineate annual trends in patient age, complication rates, and case volume by fellowship type. Analysis of variance was performed to evaluate complication rates by fellowship type. Statistical significance for all comparative analyses was set at P-value < 0.05. Results: A total of 4178 pediatric and adolescent forearm fractures (mean age: 12.6 y; SD: 3.7 y) were treated surgically among ABOS Part II Oral Examination candidates during their 6-month collection periods from 2003 to 2019. The mean patient age decreased significantly (P < 0.001) over the study timeframe, while complication rates increased (P < 0.001). Pediatric fellowshiptrained orthopaedic surgeons performed significantly more cases than general orthopaedic surgeons over recent years (P < 0.001). No significant trends were identified between fellowship type and complication rates. The overall surgical complication rate was From the

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Operative duration-based learning period analysis for reverse and total shoulder arthroplasty: A multicenter study

Cited by 6 publications

References 39 publications

Trends in operative duration of total shoulder arthroplasty from 2008 to 2018: a national database study

Trends in operative duration of total shoulder arthroplasty from 2008 to 2018: a national database study

Learning Curve Associated With Operative Treatment of Terrible Triad Elbow Fracture Dislocations

Trends in Operative Treatment of Pediatric and Adolescent Forearm Fractures Among American Board of Orthopaedic Surgery Part II Candidates

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