Zmistowski Benjamin, Warrender William, Livesey Michael, Girden Alex, Williams Gerald R, Namdari Surena
Rothman Orthopaedic Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA. Email:
Am J Orthop (Belle Mead NJ). 2018 Dec;47(12). doi: 10.12788/ajo.2018.0111.
Total shoulder arthroplasty (TSA) has proved a cost-effective, reproducible procedure for multiple shoulder pathologies. As utilization of TSA continues to grow, it is important to investigate procedure diversity, training, and other characteristics of surgeons performing TSA. To identify surgeons performing TSA in the Medicare population, the Medicare Provider Utilization and Payment Databases from 2012 through 2014 were used. This dataset includes any provider who bills Medicare >10 times with a single billing code. A web-based search was performed for each physician performing >10 TSA in all years of the study to identify their surgical training characteristics. Between 2012 and 2014, 1374 surgeons (39 females [2.8%]) performed >10 TSA in Medicare patients in at least 1 year (71,973 TSA). Only 44.3% (609/1374) of surgeons met this threshold for all 3 years (55,538 TSA). Of these 609 surgeons, 191 (31.3%) were shoulder and elbow fellowship trained (21,444 TSA). Shoulder and elbow fellowship-trained surgeons were at earlier points in their careers and practiced in large referral-based centers with other surgeons performing TSA. In addition to TSA, surgeons performed other non-arthroplasty shoulder procedures (80.2% of surgeons), total knee arthroplasty (46.3%), repairs of traumatic injuries (29.8%), total hip arthroplasty (27.8%), non-arthroplasty knee surgeries (27.2%), elbow procedures (19.6%), and hand surgery (15.4%) during the study period. With less than one-third of TSA performed by shoulder and elbow fellowship-trained surgeons with consistent moderate-volume practices, the impact of consistent high-volume practices and targeted fellowship training on quality must be determined.
全肩关节置换术（TSA）已被证明是一种针对多种肩部疾病具有成本效益且可重复实施的手术。随着TSA的应用持续增加，研究实施TSA手术的多样性、培训情况以及外科医生的其他特征变得尤为重要。为了识别在医疗保险人群中实施TSA的外科医生，我们使用了2012年至2014年的医疗保险提供者利用和支付数据库。该数据集包括任何使用单一计费代码向医疗保险机构计费超过10次的提供者。对在研究的所有年份中实施超过10例TSA手术的每位医生进行了基于网络的搜索，以确定他们的外科培训特征。在2012年至2014年期间，1374名外科医生（39名女性[2.8%]）在至少1年中为医疗保险患者实施了超过10例TSA手术（共71,973例TSA）。只有44.3%（609/1374）的外科医生在这3年中都达到了这个阈值（共55,538例TSA）。在这609名外科医生中，191名（31.3%）接受过肩肘专科培训（共21,444例TSA）。接受过肩肘专科培训的外科医生处于职业生涯的早期阶段，在大型转诊中心执业，还有其他外科医生实施TSA手术。在研究期间，除了TSA手术外，外科医生还实施了其他非关节置换的肩部手术（80.2%的外科医生）、全膝关节置换术（46.3%）、创伤修复手术（29.8%）、全髋关节置换术（27.8%）、非关节置换的膝关节手术（27.2%）、肘部手术（19.6%）和手部手术（15.4%）。由于接受肩肘专科培训且手术量稳定适中的外科医生实施的TSA手术不到三分之一，因此必须确定持续的高手术量操作和针对性的专科培训对手术质量的影响。
