肩关节置换术后外科医生手术量对疗效的影响。
Impact of Surgeon Case Volume on Outcomes After Reverse Total Shoulder Arthroplasty.
机构信息
From the Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY.
出版信息
J Am Acad Orthop Surg. 2023 Dec 15;31(24):1228-1235. doi: 10.5435/JAAOS-D-23-00181. Epub 2023 Oct 12.
INTRODUCTION
Despite a rapid increase in utilization of reverse total shoulder arthroplasty (rTSA), volume-outcome studies focusing on surgeon volume are lacking. Surgeon-specific volume-outcome studies may inform policymakers and provide insight into learning curves and measures of efficiency with greater case volume.
METHODS
This retrospective cohort study with longitudinal data included all rTSA cases as recorded in the Centers for Medicare & Medicaid Services Limited Data Set (2016 to 2018). The main effect was surgeon volume; this was categorized using two measures of surgeon volume: (1) rTSA case volume and (2) rTSA + TSA case volume. Volume cutoff values were calculated by applying a stratum-specific likelihood ratio analysis.
RESULTS
Among 90,318 rTSA cases performed by 7,097 surgeons, we found a mean annual rTSA surgeon volume of 6 ± 10 and a mean rTSA + TSA volume of 9 ± 14. Regression models using surgeon-specific rTSA volume revealed that surgery from low (<29 cases) compared with medium (29 to 96 cases) rTSA-volume surgeons was associated with a significantly higher 90-day all-cause readmission (odds ratio [OR], 1.17; confidence interval [CI], 1.10 to 1.25; P < 0.0001), higher 90-day readmission rates because of an infection (OR, 1.46; CI, 1.16 to 1.83; P = 0.0013) or dislocation (OR, 1.43; CI, 1.19 to 1.72; P = 0.0001), increased 90-day postoperative cost (+11.3% CI, 4.2% to 19.0%; P = 0.0016), and a higher transfusion rate (OR, 2.06; CI, 1.70 to 2.50; P < 0.0001). Similar patterns existed when using categorizations based on rTSA + TSA case volume.
CONCLUSION
Surgeon-specific volume-outcome relationships exist in this rTSA cohort, and we were able to identify thresholds that may identify low and medium/high volume surgeons. Observed volume-outcome relationships were independent of the definition of surgeon volume applied: either by focusing on the number of rTSAs performed per surgeon or anatomic TSAs performed.
LEVEL OF EVIDENCE
III.
简介
尽管反向全肩关节置换术（rTSA）的应用迅速增加，但缺乏针对外科医生数量的手术量-结果研究。外科医生特定的手术量-结果研究可以为决策者提供信息，并深入了解学习曲线和随着手术量增加的效率衡量标准。
方法
本回顾性队列研究采用纵向数据，纳入了医疗保险和医疗补助服务有限数据集（2016 年至 2018 年）中记录的所有 rTSA 病例。主要效果是外科医生的手术量；使用两种外科医生手术量的衡量标准对其进行分类：（1）rTSA 手术量，（2）rTSA+TSA 手术量。通过应用分层似然比分析计算了手术量的临界值。
结果
在 90318 例由 7097 名外科医生进行的 rTSA 病例中，我们发现外科医生每年 rTSA 的平均手术量为 6 ± 10，rTSA+TSA 的平均手术量为 9 ± 14。使用外科医生特定的 rTSA 手术量的回归模型显示，与中量（29 至 96 例）rTSA 手术量的外科医生相比，手术量较低（<29 例）的外科医生，90 天内所有原因的再入院率明显更高（优势比[OR]，1.17；置信区间[CI]，1.10 至 1.25；P < 0.0001），90 天内因感染（OR，1.46；CI，1.16 至 1.83；P = 0.0013）或脱位（OR，1.43；CI，1.19 至 1.72；P = 0.0001）而再次入院的比例更高，90 天术后费用增加（+11.3%CI，4.2%至 19.0%；P = 0.0016），输血率更高（OR，2.06；CI，1.70 至 2.50；P < 0.0001）。当使用基于 rTSA+TSA 手术量的分类时，也存在类似的模式。
结论
在这个 rTSA 队列中存在外科医生特定的手术量-结果关系，我们能够确定可能识别低量和中/高量外科医生的阈值。观察到的手术量-结果关系独立于应用的外科医生手术量定义：要么关注每位外科医生进行的 rTSA 数量，要么关注进行的解剖型 TSA 数量。
证据等级
III 级。
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