Southern California Kaiser Permanente, San Diego, CA, USA.
Southern California Kaiser Permanente, Irvine, CA, USA.
J Shoulder Elbow Surg. 2014 Aug;23(8):1187-94. doi: 10.1016/j.jse.2013.11.017. Epub 2014 Feb 4.
There has been a significant increase in both the incidence of shoulder arthroplasty and the number of surgeons performing these procedures. Literature regarding the relationship between surgeon or hospital volume and the performance of modern shoulder arthroplasty is limited. This study examines the effect of surgeon or hospital shoulder arthroplasty volume on perioperative metrics related to shoulder hemiarthroplasty, total shoulder arthroplasty, and reverse shoulder arthroplasty. Blood loss, length of stay, and operative time were the main endpoints analyzed.
Prospective data were analyzed from a multicenter shoulder arthroplasty registry; 1176 primary shoulder arthroplasty cases were analyzed. Correlation and analysis of covariance were used to examine the association between surgeon and hospital volume and perioperative metrics adjusting for age, sex, and body mass index.
Surgeon volume is inversely correlated with length of stay for hemiarthroplasty and total shoulder arthroplasty and with blood loss and operative time for all 3 procedures. Hospital volume is inversely correlated with length of stay for hemiarthroplasty, with blood loss for total and reverse shoulder arthroplasty, and with operative time for all 3 procedures. High-volume surgeons performed shoulder arthroplasty 30 to 50 minutes faster than low-volume surgeons did.
Higher surgeon and hospital case volumes led to improved perioperative metrics with all shoulder arthroplasty procedures, including reverse total shoulder arthroplasty, which has not been previously described in the literature. Surgeon volume had a larger effect on metrics than hospital volume did. This study supports the concept that complex shoulder procedures are, on average, performed more efficiently by higher volume surgeons in higher volume centers.
肩关节置换术的发病率和实施手术的外科医生数量都显著增加。关于外科医生或医院手术量与现代肩关节置换术表现之间关系的文献有限。本研究检查了外科医生或医院肩关节置换术量对肩关节半关节置换术、全肩关节置换术和反式肩关节置换术相关围手术期指标的影响。失血量、住院时间和手术时间是主要分析的终点。
从多中心肩关节置换登记处前瞻性分析数据；共分析了 1176 例原发性肩关节置换病例。使用相关分析和协方差分析来检查外科医生和医院量与围手术期指标之间的关联，同时调整年龄、性别和体重指数。
外科医生的手术量与半关节置换术和全肩关节置换术的住院时间呈负相关，与所有 3 种手术的失血量和手术时间呈负相关。医院的手术量与半关节置换术的住院时间呈负相关，与全肩关节置换术和反式肩关节置换术的失血量呈负相关，与所有 3 种手术的手术时间呈负相关。高容量外科医生进行肩关节置换术的速度比低容量外科医生快 30 到 50 分钟。
较高的外科医生和医院手术量导致所有肩关节置换术（包括以前文献中未描述的反式全肩关节置换术）的围手术期指标得到改善。外科医生的手术量对指标的影响大于医院的手术量。本研究支持这样一种观点，即复杂的肩部手术通常由高容量中心的高容量外科医生更有效地进行。
