We analyse the impact of implementing dual surgeon operating for reverse geometry total shoulder replacement (RGTSR) as part of the "Getting It Right First Time" (GIRFT) recommendations in our shoulder and elbow unit, and the learning curve associated with it. MethodsWe performed a retrospective cohort study comparing operative time and complication rates in patients who underwent RGTSR performed by a single consultant surgeon versus two consultant surgeons over a six-year period in a single centre, in addition to an analysing the learning curve over the same period. ResultsA total of 74 RGTSRs were performed over a six-year period: 35 patients had a single surgeon perform their procedure and 39 had dual surgeon operating. Observed complication rates for RGTSR nearly halved following the introduction of dual surgeon operating (22.9% vs 12.8%, p=0.36). The complication rate for the first 37 cases was 9/37 (24.4%) versus 4/37 (10.8%, p=0.22) for the next 37 cases. ConclusionThe implementation of dual surgeon operating may lead to reduced operative complications, provide cost savings to the hospital and produced several other non-tangible benefits to the surgeons and the department. An observed reduction in complication rates demonstrates the learning curve associated with this procedure.

In this study, we aimed to analyse the impact of implementing the "Getting It Right First Time" (GIRFT) recommendations in our shoulder and elbow unit, which included the introduction of a shoulder and elbow multidisciplinary team (MDT) meeting for all patients being considered for surgery. MethodsA retrospective patient case-note review was undertaken to assess the impact of replacing the pre-admission clinic with an MDT meeting. We analysed how many of the proposed management plans were changed as a result of this new MDT, as well as the associated cost savings. ResultsOf note, 118/148 patients who attended the MDT had a provisional operative plan; 24/118 (20%) had their plan changed to non-operative management, 13/118 (11%) had a change of operation, and 6/118 (5%) were recommended further investigations or tertiary referral. This reduced theatre time required by 47 hours, an estimated saving of over £51,000. Significantly, 20/24 patients who had their plan changed from operative to non-operative still had not had an operation after a median follow-up of 39 months. ConclusionThe introduction of a shoulder and elbow MDT for all patients being considered for an operation has improved decision-making, allowed optimisation of non-operative management, and helped prevent patients from having unnecessary operations. This has led to a better patient experience and a more efficient service delivery, which is associated with cost savings.