Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA; Fondren Orthopedic Research Institute (FORI), Houston, TX, USA; Texas Education and Research Foundation for Shoulder and Elbow Surgery, Inc. (TERFSES), Houston, TX, USA.
Fondren Orthopedic Research Institute (FORI), Houston, TX, USA; Texas Education and Research Foundation for Shoulder and Elbow Surgery, Inc. (TERFSES), Houston, TX, USA.
J Shoulder Elbow Surg. 2020 Jul;29(7):e279-e286. doi: 10.1016/j.jse.2019.11.023. Epub 2020 Feb 19.
Total shoulder arthroplasty (TSA) with an anatomic or reverse prosthesis is a commonly used and successful treatment option for many degenerative shoulder conditions. There is an increasing trend toward fellowship training and subspecialization in newly trained orthopedic surgeons. The literature also suggests that subspecialization and high volume are associated with better clinical outcomes. The purpose of this study was to evaluate the effects of fellowship training on the trends and outcomes of TSA in board-eligible orthopedic surgeons.
The American Board of Orthopaedic Surgery database was used to identify primary TSA cases performed for osteoarthrosis submitted by American Board of Orthopaedic Surgery Part II Board Certification candidates. Candidates were grouped based on fellowship training and subspecialty examination being taken. Groups were analyzed with analysis of variance and Bonferroni post hoc analysis to evaluate significant differences between groups for a number of candidates, cases per candidate, and patient age/sex. Differences in complications, reoperations, and readmissions were statistically evaluated with χ tests and multivariate logistic regression analysis.
From 2010 to 2017, 854 candidates performed at least 1 primary TSA (anatomic or reverse) after a diagnosis of osteoarthritis and 2720 submitted cases met inclusion criteria. Candidates completing a Shoulder fellowship performed significantly more TSAs per candidate compared with all other groups (Shoulder = 8.0 ± 6.2, Sports Medicine = 2.4 ± 2.1, Hand and Upper Extremity = 2.9 ± 2.9, General Orthopedics = 2.4 ± 2.3, P < .001). The Shoulder fellowship group had significantly lower complication rates (17.9%) as compared with the Sports Medicine fellowship (23.7%, P = .008) and Hand and Upper Extremity fellowship (25.0%, P = .008) groups.
Shoulder fellowship-trained surgeons performed significantly more TSAs per year than other groups, with a lower complication rate when compared with other fellowship-trained candidates. Fellowship type had no effect on reoperation or readmission rates.
全肩关节置换术（TSA）采用解剖型或反式假体，是许多退行性肩部疾病的常用且有效的治疗选择。在新培训的骨科医生中， fellowship 培训和亚专业培训的趋势越来越明显。文献还表明，专业化和高容量与更好的临床结果相关。本研究的目的是评估 fellowship 培训对符合委员会资格的骨科医生进行 TSA 趋势和结果的影响。
使用美国骨科医师协会委员会数据库，确定由美国骨科医师协会委员会第 II 部分认证候选人提交的因骨关节炎而进行的初次 TSA 病例。候选人根据 fellowship 培训和正在接受的亚专业考试进行分组。使用方差分析和 Bonferroni 事后分析对多个候选人、每位候选人的病例数和患者年龄/性别组之间的显著差异进行分析。使用 χ 检验和多变量逻辑回归分析对并发症、再次手术和再入院的差异进行统计学评估。
2010 年至 2017 年，854 名候选人在诊断为骨关节炎后至少进行了 1 次初次 TSA（解剖型或反式），2720 例提交的病例符合纳入标准。完成肩部 fellowship的候选人每位候选人完成的 TSA 数量明显多于其他所有组（肩部 = 8.0 ± 6.2，运动医学 = 2.4 ± 2.1，手和上肢 = 2.9 ± 2.9，普通骨科 = 2.4 ± 2.3，P <.001）。肩部 fellowship组的并发症发生率明显低于运动医学 fellowship组（23.7%，P =.008）和手和上肢 fellowship组（25.0%，P =.008）。
肩部 fellowship培训的外科医生每年进行的 TSA 数量明显多于其他组，与其他 fellowship培训的候选人相比，并发症发生率较低。 fellowship 类型对再次手术或再入院率没有影响。
