Recurrent shoulder instability often leads to labral abnormality that requires surgical intervention that may require fixation with suture anchors. The proposed surgical technique allows the surgeon to achieve 2 points of fixation around the labrum and/or capsule with a single suture secured to the glenoid with a knotless anchor. Instead of cutting and discarding the residual suture limbs after anchor insertion, this technique uses the residual suture limbs of the knotless anchor for a second suture pass. This technique (1) creates a more cost-and time-efficient surgical procedure than using multiple single-loaded anchors or double-loaded anchors, (2) decreases the known risk of glenoid fracture from the stress riser at the implant tips of multi-anchor repairs by reducing the number of anchors required for stabilization, (3) decreases the surgical time compared with the use of double-loaded anchors through simpler suture management and less knot tying, (4) allows for the secure reapproximation of the labrum to the glenoid while offering a convenient option for capsulorrhaphy without the need to insert another anchor, and (5) yields more points of soft-tissue fixation with fewer anchors drilled into the glenoid.

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Background Anesthesiology residents acquire clinical skills and acumen primarily from experience providing anesthesia for procedural cases, with prior preparation maximizing learning. Ambulatory surgery and associated management styles create fluid anesthesiology staffing—reducing predictability for learners and disrupting continuity of care. Objective This prospective, observational study aimed to quantify anesthesia personnel changes in the operating rooms of a single teaching hospital. Methods For a 5-week period, Monday through Friday, we recorded the surgical schedule on the prior evening. After the day of surgery, tracking software provided a list of cases performed. We completed electronic health record review for each case, recorded the actual anesthesiology personnel involved, and compared that to the personnel originally scheduled. We also recorded the occurrence of any permanent transitions of care within a case, the type of operation, and the anesthesia start and end times. Results Anesthesia providers included 47 residents and 32 attending physicians. The study period included 1285 scheduled cases, 55% (n  =  711) of which were started and finished by the originally scheduled resident and attending physician. Including canceled cases (126 of 1285, 10%) and added cases (207 of 1366, 15%), residents started anesthetics on patients and with attending physicians assigned to them from the day before 54% of the time. Transitions of care occurred in 19% (260 of 1366) of the cases. Conclusions Anesthesiology residents prepare for many procedures that do not eventuate and frequently start other cases without prior opportunity for preparation and study. Transitions of care further reduce continuity of care and fragment supervision.

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