Advanced

Lower operating volume in shoulder arthroplasty is associated with increased revision rates in the early postoperative period : long-term analysis from the Australian Orthopaedic Association National Joint Replacement Registry

Brown, Jamie S. LU ; Gordon, Robert J. ; Peng, Yi ; Hatton, Alesha ; Page, Richard S. and Macgroarty, Kelly A. (2020) In Journal of Shoulder and Elbow Surgery
Abstract

Background: Improved short-term outcomes have been demonstrated with higher surgical volume in shoulder arthroplasty. There is however, little data regarding long-term outcomes. Method: Revision data from the Australian Orthopaedic Association National Joint Replacement Registry from 2004-2017 was analyzed according to 3 selected surgeon volume thresholds: <10, 10-20, and >20 shoulder arthroplasty cases per surgeon, per year. Results: There was a significantly higher rate of revision for stemmed total shoulder arthroplasty (TSA) for osteoarthritis (OA) for the <10/yr compared with the >20/yr group for the first 1.5 years only (hazard ratio [HR] 1.36, 95% confidence interval [CI] 1.08-1.71, P =. 009). For reverse total... (More)

Background: Improved short-term outcomes have been demonstrated with higher surgical volume in shoulder arthroplasty. There is however, little data regarding long-term outcomes. Method: Revision data from the Australian Orthopaedic Association National Joint Replacement Registry from 2004-2017 was analyzed according to 3 selected surgeon volume thresholds: <10, 10-20, and >20 shoulder arthroplasty cases per surgeon, per year. Results: There was a significantly higher rate of revision for stemmed total shoulder arthroplasty (TSA) for osteoarthritis (OA) for the <10/yr compared with the >20/yr group for the first 1.5 years only (hazard ratio [HR] 1.36, 95% confidence interval [CI] 1.08-1.71, P =. 009). For reverse total shoulder arthroplasty (rTSA) performed for OA, there was a higher revision rate for the <10/yr compared with the >20/yr group for the first 3 months only (HR 2.58, 95% CI 1.67-3.97, P < .001). In rTSA for cuff arthropathy, there was a significantly higher rate of revision for the <10/yr compared with the >20/yr group throughout the follow-up period (HR 1.66, 95% CI 1.21-2.28, P =. 001). There was no significant difference for the primary diagnosis of fracture. Conclusion: Lower surgical volume was associated with higher all-cause revision rates in the early postoperative period in TSA and rTSA for OA and throughout the follow-up period in rTSA for cuff arthropathy. Despite increases in the volume of shoulder arthroplasties performed in recent years, more than 78% of surgeons undertake fewer than 10 procedures per year.

(Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
arthroplasty register, Australian Orthopaedic Association National Joint Replacement Registry, Level III, Retrospective Cohort Comparison with Large Database Analysis, reverse shoulder arthroplasty, revision rate, surgical volume, Total shoulder arthroplasty, total shoulder replacement, Treatment Study
in
Journal of Shoulder and Elbow Surgery
publisher
Mosby
external identifiers
  • pmid:32044253
  • scopus:85079186646
ISSN
1058-2746
DOI
10.1016/j.jse.2019.10.026
language
English
LU publication?
yes
id
999cc4ef-772c-44ac-949b-9b578d0f9b39
date added to LUP
2020-02-21 14:50:39
date last changed
2020-02-26 07:42:39
@article{999cc4ef-772c-44ac-949b-9b578d0f9b39,
  abstract     = {<p>Background: Improved short-term outcomes have been demonstrated with higher surgical volume in shoulder arthroplasty. There is however, little data regarding long-term outcomes. Method: Revision data from the Australian Orthopaedic Association National Joint Replacement Registry from 2004-2017 was analyzed according to 3 selected surgeon volume thresholds: &lt;10, 10-20, and &gt;20 shoulder arthroplasty cases per surgeon, per year. Results: There was a significantly higher rate of revision for stemmed total shoulder arthroplasty (TSA) for osteoarthritis (OA) for the &lt;10/yr compared with the &gt;20/yr group for the first 1.5 years only (hazard ratio [HR] 1.36, 95% confidence interval [CI] 1.08-1.71, P =. 009). For reverse total shoulder arthroplasty (rTSA) performed for OA, there was a higher revision rate for the &lt;10/yr compared with the &gt;20/yr group for the first 3 months only (HR 2.58, 95% CI 1.67-3.97, P &lt; .001). In rTSA for cuff arthropathy, there was a significantly higher rate of revision for the &lt;10/yr compared with the &gt;20/yr group throughout the follow-up period (HR 1.66, 95% CI 1.21-2.28, P =. 001). There was no significant difference for the primary diagnosis of fracture. Conclusion: Lower surgical volume was associated with higher all-cause revision rates in the early postoperative period in TSA and rTSA for OA and throughout the follow-up period in rTSA for cuff arthropathy. Despite increases in the volume of shoulder arthroplasties performed in recent years, more than 78% of surgeons undertake fewer than 10 procedures per year.</p>},
  author       = {Brown, Jamie S. and Gordon, Robert J. and Peng, Yi and Hatton, Alesha and Page, Richard S. and Macgroarty, Kelly A.},
  issn         = {1058-2746},
  language     = {eng},
  month        = {02},
  publisher    = {Mosby},
  series       = {Journal of Shoulder and Elbow Surgery},
  title        = {Lower operating volume in shoulder arthroplasty is associated with increased revision rates in the early postoperative period : long-term analysis from the Australian Orthopaedic Association National Joint Replacement Registry},
  url          = {http://dx.doi.org/10.1016/j.jse.2019.10.026},
  doi          = {10.1016/j.jse.2019.10.026},
  year         = {2020},
}