Patient Outcomes as a Function of Shoulder Surgeon Volume: A Systematic Review

Weinheimer, Kent T.; Smuin, Dallas M.; Dhawan, Aman

doi:10.1016/j.arthro.2017.03.005

Cited by 69 publications

(43 citation statements)

References 21 publications

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“…The percentage of patients with failure after tendon to bone repair is relatively high. [34][35][36] The insertion of tendon/ ligament and bone is a strong mechanical structure established via a collagen fiber architecture and mineral composition in the native enthesis. 5,37-39 Therefore, it is likely that a fibrous membrane system that generates a fiber architecture and mineral composition will increase the feasibility of tendon to bone healing and may be the key to improve clinical prognosis.…”

Section: Discussionmentioning

confidence: 99%

<p>Promoting tendon to bone integration using graphene oxide-doped electrospun poly(lactic-co-glycolic acid) nanofibrous membrane</p>

Su¹,

Wang²,

Jiang³

et al. 2019

IJN

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Background These normal entheses are not reestablished after repair despite significant advances in surgical techniques. There is a significant need to develop integrative biomaterials, facilitating functional tendon-to-bone integration. Materials and methods We fabricated a highly interconnective graphene oxide-doped electrospun poly(lactide-co-glycolide acid) (GO-PLGA) nanofibrous membrane by electrospinning technique and evaluated them using in vitro cell assays. Then, we established rabbit models, the PLGA and GO-PLGA nanofibrous membranes were used to augment the rotator cuff repairs. The animals were killed postoperatively, which was followed by micro-computed tomography, histological and biomechanical evaluation. Results GO was easily mixed into PLGA filament without changing the three dimensional microstructure. An in vitro evaluation demonstrated that the PLGA membranes incorporated with GO accelerated the proliferation of BMSCs and furthered the Osteogenic differentiation of BMSCs. In addition, an in vivo assessment further revealed that the local application of GO-PLGA membrane to the gap between the tendon and the bone in a rabbit model promoted the healing enthesis, increased new bone and cartilage generation, and improved collagen arrangement and biomechanical properties in comparison with repair with PLGA only. Conclusion The electrospun GO-PLGA fibrous membrane provides an effective approach for the regeneration of tendon to bone enthesis.

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Section: Discussionmentioning

confidence: 99%

<p>Promoting tendon to bone integration using graphene oxide-doped electrospun poly(lactic-co-glycolic acid) nanofibrous membrane</p>

Su¹,

Wang²,

Jiang³

et al. 2019

IJN

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“…23 Similarly, studies have found that patients undergoing shoulder arthroplasty performed by low-volume shoulder surgeons are more likely to have postoperative complications, longer length of stay, increased operative time, and higher surgical cost. 24,25 In the literature, there have been multiple methods utilized to analyze a surgeon's experience and quantify a surgical learning curve. Such methods include analysis of decreases in complication rates, 18,26 rate of revision, 20 operative time, 27,28 outcomes, 20,29 and 30-day readmission rates.…”

Section: Introductionmentioning

confidence: 99%

Operative duration-based learning period analysis for reverse and total shoulder arthroplasty: A multicenter study

et al. 2018

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Background: A surgical learning period may be quantified after which operative duration is significantly reduced. We sought to retrospectively quantify and compare surgeon's learning experience for total shoulder arthroplasty and reverse shoulder arthroplasty. Methods: We reviewed 2055 shoulder arthroplasty cases from 2011 to 2015 for four early-career and four later-career fellowship-trained shoulder surgeons from four institutions. We plotted consecutive case number versus operative time for each surgeon separately for total shoulder arthroplasty or reverse shoulder arthroplasty. Two-step regression approach was used to determine a plateau point or end of the learning period. Additionally, the mean annual volume of reverse shoulder arthroplasty and total shoulder arthroplasty for each surgeon was plotted against mean surgery duration. Early-and later-career surgeons were compared with regression analysis. Results: Early-career surgeons demonstrated a significant decrease in operative time with increasing annual case volume for reverse shoulder arthroplasty (p ¼ 0.01; m ¼ À1.1) and total shoulder arthroplasty (p ¼ 0.02; m ¼ À0.8). Three of four early-career surgeons reached a plateau point for either reverse shoulder arthroplasty or total shoulder arthroplasty between 12 and 86 cases. Conclusion: For only early-career surgeons, higher case volume yields decreased operative duration, with improvement more pronounced for reverse shoulder arthroplasty compared to total shoulder arthroplasty. Though the learning period varies, it may be fewer than 90 cases.

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“…It has previously been shown that physicians who perform a higher volume of RCR procedures tend to have lower costs, less time in the operating room, lower readmission rates, and lower complication rates leading to reoperations. 15,22,26 Facility volume has also been examined. Sherman et al 22 found that hospital volume was not a risk factor for readmissions, although their data included both open and arthroscopic RCR procedures and covered the time period from 1997 to 2002.…”

mentioning

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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Patient Outcomes as a Function of Shoulder Surgeon Volume: A Systematic Review

Cited by 69 publications

References 21 publications

<p>Promoting tendon to bone integration using graphene oxide-doped electrospun poly(lactic-co-glycolic acid) nanofibrous membrane</p>

<p>Promoting tendon to bone integration using graphene oxide-doped electrospun poly(lactic-co-glycolic acid) nanofibrous membrane</p>

Operative duration-based learning period analysis for reverse and total shoulder arthroplasty: A multicenter study

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

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