Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
J Shoulder Elbow Surg. 2018 Jun;27(6S):S82-S87. doi: 10.1016/j.jse.2018.01.018.
Recently, outpatient total shoulder arthroplasty (TSA) has been proposed as a safe and cost-effective alternative to the inpatient setting. This study evaluated the expert shoulder surgeon's experience with and perceived barriers to outpatient TSA.
A secure web application was used to perform an online survey of 484 active American Shoulder and Elbow Surgeons members. The survey assessed surgeon practice demographics, experience with TSA/outpatient TSA, and perceived barriers to successful outpatient TSA. Simple descriptive statistics were performed to analyze the cohort. To identify differences between surgeons performing and not performing outpatient TSA, the Student t test and χ test were used in bivariate analysis. P < .05 was used for statistical significance.
Of the 179 (37.0%) complete responses received, 20.7% perform outpatient TSA; of those, 78.4% reported an "excellent" experience. Outpatient surgeons were more likely to reside in the southern United States (P = .05) and performed a higher volume of TSAs annually (P = .03). Surgeons not performing outpatient TSA were more concerned with the potential of medical complications (P = .04). Perceived lack of experience (P = .002), low volume (P = .008), insurance contracts (P = .003), and reimbursement (P = .04) were less important barriers compared with outpatient TSA surgeons.
Less than 25% of shoulder surgeons who completed survey are performing outpatient TSA, and those that do report an overall excellent experience. Volume of TSAs performed and practice location appear to play roles in the decision to perform outpatient TSA. As surgeons become more comfortable with outpatient TSA, there is a shift from concerns about medical complications to concerns about reimbursement.
最近，门诊全肩关节置换术（TSA）已被提出作为住院治疗的安全且具有成本效益的替代方案。本研究评估了专家肩部外科医生对门诊 TSA 的经验和感知障碍。
使用安全的网络应用程序对 484 名活跃的美国肩部和肘部外科医生成员进行了在线调查。该调查评估了外科医生的实践人口统计学、TSA/门诊 TSA 经验以及成功进行门诊 TSA 的感知障碍。简单的描述性统计数据用于分析队列。为了确定进行和不进行门诊 TSA 的外科医生之间的差异，在双变量分析中使用了 Student t 检验和 χ 检验。P < .05 用于统计学意义。
在收到的 179 份（37.0%）完整回复中，20.7%的人进行门诊 TSA；其中 78.4%报告了“出色”的经验。门诊外科医生更可能居住在美国南部（P = .05），并且每年进行的 TSA 数量更高（P = .03）。不进行门诊 TSA 的外科医生更担心潜在的医疗并发症（P = .04）。与门诊 TSA 外科医生相比，缺乏经验（P = .002）、低容量（P = .008）、保险合同（P = .003）和报销（P = .04）被认为是不太重要的障碍。
不到 25%的完成调查的肩部外科医生正在进行门诊 TSA，而且那些确实报告了整体出色经验的医生。进行 TSA 的数量和实践地点似乎在决定进行门诊 TSA 方面发挥作用。随着外科医生对门诊 TSA 的适应程度提高，从对医疗并发症的担忧转变为对报销的担忧。
