Arthroscopic and Open or Mini-Open Rotator Cuff Repair Trends and Complication Rates Among American Board of Orthopaedic Surgeons Part II Examinees (2007-2017)

Kelly, Blane C.; Constantinescu, David S.; Vap, Alexander R.

doi:10.1016/j.arthro.2019.06.022

Cited by 23 publications

(17 citation statements)

References 14 publications

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“…The overall risk of experiencing a local postoperative AE in this study was higher than that generally referenced by the working groups of Strauss, Brislin and Kelly (2.5-16.2%) [14][15][16] . An explanation could be the specific focus of our study on AEs as well as the standardized and comprehensive AE documentation process according to the CES.…”

Section: Discussioncontrasting

confidence: 59%

Complications Within 6 Months After Arthroscopic Rotator Cuff Repair: Registry-Based Evaluation According to a Core Event Set and Severity Grading

Felsch

Mai

Durchholz

et al. 2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Section: Discussioncontrasting

confidence: 59%

Complications Within 6 Months After Arthroscopic Rotator Cuff Repair: Registry-Based Evaluation According to a Core Event Set and Severity Grading

Felsch

Mai

Durchholz

et al. 2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…23 Although previous literature did not establish a definitive difference in outcomes between arthroscopic versus open/mini-open RCR repair, 9,[24][25][26][27] the use of the ABOS database demonstrated that arthroscopic RCR is increasingly performed over open RCR and has a lower complication rate. 10 One possible explanation for this is that greater RCR competency is achieved with the repair method that the surgeon performs more often. However, this finding may also be confounded as the ABOS database does not specify between rotator cuff properties and an open repair method may have been required on larger and more complex tears.…”

Section: Discussionmentioning

confidence: 99%

“… 5 , 6 , 7 , 8 , 9 However, a recent demonstration using the American Board of Orthopaedic Surgery (ABOS) database proved an increasing use of arthroscopic RCR techniques as well as a lower complication rate over open/mini-open RCR. 10 Orthopaedic surgeons are increasingly becoming fellowship trained, 11 and the training resources throughout fellowship influence the practice patterns of RCR. 12 This gives rise to the question of whether fellowship training affects practice patterns and complication rates of RCR.…”

mentioning

confidence: 99%

Arthroscopic Versus Open Rotator Cuff Repair: Fellowship-Trained Orthopaedic Surgeons Prefer Arthroscopy and Self-Report a Lower Complication Rate

Kelly

Constantinescu

Pavlis

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To evaluate whether fellowship training had an effect on the practice pattern and complication rates among Part II examinees of the American Board of Orthopaedic Surgery (ABOS) for rotator cuff repair (RCR) from 2007-2017. Methods: The ABOS database was queried for arthroscopic (Current Procedural Terminology [CPT] code 29827) and open/mini-open (CPT codes: 23410, 23412) RCR performed from 2007-2017. Excluded were procedures that did not included CPT codes 29827, 23410, 23412. A comparison between arthroscopic and open/mini-open use as well as selfreported complications were assessed based on recorded fellowship training. Results: A total of 31,907 RCR were reported over the past 10 years (2007-2017). The percentage of RCR procedures performed using arthroscopic technique vs open/mini-open varied among surgeons who completed one fellowship: Sports Medicine (92.5 % arthroscopy; 7.5 % mini/ open), Shoulder & Elbow (91.3 % arthroscopy; 8.7% mini/open), and Hand & Upper Extremity (69.6 % arthroscopy; 30.4 % open). Total complication rates varied among surgeons who completed one fellowship: Sports Medicine (11.5 %), Shoulder & Elbow (13.5 %), and Hand & Upper Extremity (13.4 %). Surgeons completing one fellowship in either Sports Medicine, Shoulder & Elbow, Hand & Upper Extremity all reported significantly lower complication rates using arthroscopic over mini/open technique (P < .001). Conclusions: Among ABOS Part II examinees completing a Sports Medicine, Shoulder and Elbow or Hand and Upper Extremity fellowship, Sports Medicine trained surgeons had significantly greater rates of performing arthroscopic over open RCR and significantly lower self-reported intraoperative complication rates. Clinical Relevance: Understanding the effects of fellowship training may guide mentors and future trainees.

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“…Between 2004 and 2017, the percentage of arthroscopic RCRs ranged between 65% to 85%, and the percentage of open RCRs ranged between 15% and 35% depending on the database and ICD codes used for query. [7][8][9][10]17,18 Several studies have noted a rise in incidence of arthroscopic RCRs and corresponding decline in incidence of open RCRs. 6,7,10,18,19 Zhang et al 18 and Day et al 7 found that the proportion of open RCR increased with increasing patient age, and Day et al 7 also found no significant difference between male and female patients in the proportion of arthroscopic or open surgeries, 7 which aligned with our current study's results.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Arthroscopic Rotator Cuff Repair Results in Lower Two-Year Reoperation Rates Compared With Open Rotator Cuff Repair in a Large Cross-sectional Cohort

Truong

Cevallos

Lansdown

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To use a large, contemporary database to perform a cross-sectional analysis of current practice trends in rotator cuff repair (RCR) for the treatment of full-thickness rotator cuff tear (RCT) and determine outcomes of arthroscopic and open RCR, including hospital readmissions and 2-year reoperation rates with accurate laterality tracking using International Classification of Diseases, Tenth Revision (ICD-10) codes. Methods: The PearlDiver Mariner dataset was used to query patients with full-thickness RCTs from 2010 to 2017. Propensity-score matching was performed to account for differences in age and comorbidities and allow for comparison between those undergoing open RCR and arthroscopic RCR. Subsequent procedures were tracked using ICD-10 codes to identify ipsilateral surgery within 2 years of index surgery. Hospital and emergency department admission within 30 days of surgery were investigated. Results: Of 534,076 patients diagnosed with full-thickness RCT, 37% underwent RCR; 73% of which were arthroscopic. From 2010 to 2017, arthroscopic RCRs increased from 65% to 80%, whereas open RCRs decreased from 35% to 20% (P < .0001). Younger patients underwent arthroscopic RCR more frequently, and patients who underwent open RCR had greater rates of 30-day emergency department (7.0%) and hospital readmission (2.0%) compared with arthroscopic RCR (6.3%, 1.0%, respectively) (P < .0001). For 24,392 patients with ICD-10 coding and 2-year follow-up, 10.4% of patients required reoperation, with the most common procedure being revision RCR, and 1.3% required conversion to arthroplasty. Open RCRs were more likely to require subsequent surgery (11.3%) compared with arthroscopic RCR (9.5%) (P < .0001). Patients aged 50 to 59 had the greatest rate of reoperation (14.0%), but no patients younger than age 40 years required reoperation, and no patients younger than age 50 years required conversion to arthroplasty. Conclusions: The frequency of arthroscopic RCR has continued to increase compared to open RCR. In this large cross-sectional analysis, arthroscopic RCR demonstrated lower 2-year reoperation rates and 30-day readmission rates compared to open RCR. Level of Evidence: III, cross-sectional study.R otator cuff tears (RCTs) have been described as one of the most common shoulder injuries associated with increasing age, 1,2 with an estimated occurrence in 30% of adults older than age 60 years and 62% of adults older than age 80 years. 3 As such, rotator cuff repair (RCR) surgery has become one of the most frequently performed shoulder procedures in orthopaedic surgery. 1,2 The exact incidence of RCTs and RCRs in the United States is currently unknown, but Mather et al. 1 estimated that, as of 2013, RCTs accounted for more than 4.5 million hospital visits in the US each year and more than 250,000 RCRs were performed annually. The implementation of administrative claims databases and Current Procedural Technology (CPT) codes has helped to increase the amount of information available regarding this topic. 4,5 For example, C...

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Arthroscopic and Open or Mini-Open Rotator Cuff Repair Trends and Complication Rates Among American Board of Orthopaedic Surgeons Part II Examinees (2007-2017)

Cited by 23 publications

References 14 publications

Complications Within 6 Months After Arthroscopic Rotator Cuff Repair: Registry-Based Evaluation According to a Core Event Set and Severity Grading

Complications Within 6 Months After Arthroscopic Rotator Cuff Repair: Registry-Based Evaluation According to a Core Event Set and Severity Grading

Arthroscopic Versus Open Rotator Cuff Repair: Fellowship-Trained Orthopaedic Surgeons Prefer Arthroscopy and Self-Report a Lower Complication Rate

Arthroscopic Rotator Cuff Repair Results in Lower Two-Year Reoperation Rates Compared With Open Rotator Cuff Repair in a Large Cross-sectional Cohort

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