The influence of patient- and surgeon-specific factors on operative duration and early postoperative outcomes in shoulder arthroplasty

Clark, Jonathan; Simon, Péter; Clark, Rachel; Christmas, Kaitlyn N.; Allert, Jesse; Streit, Jonathan J.; Mighell, Mark A.; Hess, Alfred V.; Stone, Jeffrey D.; Frankle, Mark A.

doi:10.1016/j.jse.2016.10.025

Cited by 26 publications

(6 citation statements)

References 20 publications

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“…Higher physician caseload has been shown to decrease operative time and postoperative length of stay in total shoulder arthroplasty. 5 It has also been shown to decrease the risk of postoperative admission and nonroutine patient disposition upon discharge in RCR. 15 Scott et al 21 found that high-volume providers convey a substantial economic benefit over low-volume providers because of shorter admission periods and lower rates of readmission.…”

Section: Discussionmentioning

confidence: 99%

Disparities in Cost and Access by Caseload for Arthroscopic Rotator Cuff Repair: An Analysis of 18,616 Cases

Bokshan

Mehta

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: Surgeon caseload has been shown to affect both health and economic outcomes in arthroscopic rotator cuff repair. Although previous studies have investigated disparities in access to care, little is known about disparities between low- and high-volume surgeons and facilities. Purpose: To identify where disparities may exist regarding access to high-volume surgeons and facilities. Study Design: Cross-sectional study. Methods: Univariate analysis was performed to analyze differences in the caseload between low- and high-volume surgeons and facilities. Cutoff values were set at 50 cases per year for high-volume surgeons and 125 cases annually for high-volume facilities. Multiple linear regression was then used to develop a cost model incorporating all variables significant under univariate analysis. We collected 18,616 cases with Current Procedural Terminology code 29827 (“arthroscopic rotator cuff repair”) from the 2014 Florida State Ambulatory Surgery and Services Databases. Results: A greater proportion of the caseload for low-volume surgeons and facilities was composed of patients who were of lower socioeconomic status, had government-subsidized insurance, or lived in areas with low-income ZIP codes. Low-volume surgeons and facilities also had higher total charges, higher postoperative admission rates, and lower distal clavicle excision rates ( P < .001). In our cost model, a low facility volume significantly increased costs. Subacromial decompression, postoperative admission, distal clavicle excision, male sex, and government-subsidized insurance were all significant factors for increased costs in multivariate cost analysis. Conclusion: There are disparities in access to high-volume surgeons and facilities for patients undergoing arthroscopic rotator cuff repair in Florida. Patients with a lower socioeconomic status, government-subsidized insurance, and low income all faced decreased access to these high-volume groups. High-volume surgeons and facilities were associated with lower total charges, higher rates of distal clavicle excision, and lower readmission rates. Low-volume facilities added a significant amount of cost, even when controlling for all other significant variables. It is important for providers to be aware of these disparities and work to address them in their own practices.

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Section: Discussionmentioning

confidence: 99%

Disparities in Cost and Access by Caseload for Arthroscopic Rotator Cuff Repair: An Analysis of 18,616 Cases

Bokshan

Mehta

et al. 2019

Orthopaedic Journal of Sports Medicine

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“…Longer operative duration can be a risk factor for the nerve injury as per previous study [24]. According to Clark et al [27], a 'high-volume' shoulder arthroplasty surgeon being de ned as having done more than 30 arthroplasties per year, has shorter operative duration in average of 105.9 minutes versus 128.3 minutes. Another study has found those arthroplasties performed under 90 minutes had fewer complications than those done with duration of more than 120 minutes [28], classifying the operative duration of more than 120 minutes as longer than standard.…”

Section: Discussionmentioning

confidence: 81%

Hoarseness After Shoulder Surgery in Beach-chair Position

Youn

Rhee

Kim

et al. 2021

Preprint

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Background Isolated vocal cord palsy resulting hoarseness after shoulder surgery in beach-chair position had not been reported in literature to date. The purpose of this study was to review its incidence in our patient cohort, and identify any risk factors that may predispose the patient to the injury.Methods There were 10215 operative shoulder cases from January 2010 to December 2017. Inclusion criteria was any post-operative patients, whose operation was performed under general anesthesia in beach-chair position, who had the related symptoms, but the diagnoses had to be confirmed by otorhinolaryngologists with laryngoscopy studies. The affected patients’ clinical notes were retrospectively reviewed with the particular interest in the operative times, and the peri-operative cervical spine radiographs. The degree of cervical spine lordosis was assessed using a method described in literature, in which ‘absolute rotation angle’ (ARA) was measured. Results There were 8 reported cases of vocal cord injury in total (0.08%). Four were male patients and four were arthroscopic cases. The mean age was 59.4 ± 11.9 years old. No particular difficulties with positioning or intubation were documented. The average duration of anesthetic times was 141 minutes. On peri-operative cervical spine radiographs, the average lordosis was 8.2° (1.5° kyphosis - 21° lordosis), and except for one patient, all had ‘non-lordotic’ type curvatures. All but one patient had recovered fully with observation and expectant management, with the average recovery time being 19 weeks (range: 2 weeks to 1 year). Only patient who had not recovered during our 2-year follow-up period, had a ‘sigmoidal’ type cervical spine and was also managed with observation only.Conclusions The incidence of vocal cord injury with beach-chair positioning at our institution was low at 0.08%. The possible risk factors include long duration of the procedure and ‘non-lordotic’ cervical spine, as demonstrated by the trend in our study. Although rare, vocal cord injury has varying duration of recovery time, in the worst-case scenario being permanent, therefore it needs to be avoided by taking utmost care during positioning of the patient in beach-chair. Level of Evidence Level IV, case series

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“…Clark and colleagues found that increased operative times in shoulder arthroplasty is associated with a higher incidence of unplanned readmission within 30 days after anatomic TSA J o u r n a l P r e -p r o o f and RSA. 10 Kandil et al performed a large database study of 51,191 patients who underwent anatomic TSA and found a blood transfusion rate of 6.1%. They determined that patients who required a blood transfusion had significantly longer hospital stays and total patient encounter charges.…”

Section: Discussionmentioning

confidence: 99%

Conversion of anatomic total shoulder arthroplasty to reverse shoulder arthroplasty using a unique hybrid glenoid component: technique and preliminary results

Bitzer

Rondinelli

Hurwit

et al. 2022

JSES Reviews, Reports, and Techniques

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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The influence of patient- and surgeon-specific factors on operative duration and early postoperative outcomes in shoulder arthroplasty

Cited by 26 publications

References 20 publications

Disparities in Cost and Access by Caseload for Arthroscopic Rotator Cuff Repair: An Analysis of 18,616 Cases

Disparities in Cost and Access by Caseload for Arthroscopic Rotator Cuff Repair: An Analysis of 18,616 Cases

Hoarseness After Shoulder Surgery in Beach-chair Position

Conversion of anatomic total shoulder arthroplasty to reverse shoulder arthroplasty using a unique hybrid glenoid component: technique and preliminary results

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