Harkin William E, Berreta Rodrigo Saad, Turkmani Amr, Williams Tyler, Scanaliato John P, McCormick Johnathon R, Nicholson Gregory P, Garrigues Grant E
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
J Shoulder Elbow Surg. 2025 Feb;34(2):499-506. doi: 10.1016/j.jse.2024.05.014. Epub 2024 Jun 27.
Total shoulder arthroplasty is performed by orthopedic surgeons with various fellowship training backgrounds. Whether surgeons performing shoulder arthroplasty with different types of fellowship training have differing rates of complications and reoperation remains unknown.
The PearlDiver Mariner database was retrospectively queried from the years 2010 to 2022. Patients undergoing shoulder arthroplasty were selected using the CPT code 23472. Those undergoing revision arthroplasty and those with a history of fracture, infection, or malignancy were excluded. Fellowship was determined and verified via online search. Only surgeons who performed a minimum of 10 cases were selected; and PearlDiver was queried using their provider ID codes. Primary outcome measures included 90-day, 1-year, and 5-year rates of complication and reoperation. A Bonferroni correction was utilized in which the significance threshold was set at P ≤ .00023.
In total, 150,385 patients met the inclusion criteria and were included in the study. Analysis of surgical trends revealed that Sports Medicine and Shoulder and Elbow fellowship-trained surgeons are performing an increasing percentage of all shoulder arthroplasty over time, with each cohort exhibiting an 11.3% and 4.2% increase from 2010 to 2022, respectively. The geographic region with the highest proportion of cases performed by Sports Medicine surgeons was the West, while the Northeast has the highest proportion of cases performed by Shoulder and Elbow surgeons. Shoulder and Elbow surgeons operated on patients that were significantly younger and had fewer comorbidities. Both Shoulder and Elbow and Sports Medicine surgeons had lower rates of postoperative complications at 90 days, 1 year, and 5 years in comparison to surgeons who completed another type of fellowship or no fellowship. Across each time point, the rates of individual complications between Sports Medicine and Shoulder and Elbow were comparable, but the pooled complication rate was lowest in the Shoulder and Elbow cohort.
Surgeons who have completed either a Sports Medicine or Shoulder and Elbow fellowship are performing an increasing proportion of shoulder arthroplasty over time. Sports Medicine and Shoulder and Elbow-trained surgeons have significantly lower complication rates at 90 days, 1 year, and 5 years postoperatively. The individual complication rates between Sports Medicine and Shoulder and Elbow are comparable, but Shoulder and Elbow have the lowest pooled complication rates overall.
全肩关节置换术由具有不同专科培训背景的骨科医生实施。接受不同类型专科培训的医生在进行肩关节置换术时并发症发生率和再次手术率是否存在差异尚不清楚。
对PearlDiver Mariner数据库2010年至2022年的数据进行回顾性查询。使用CPT编码23472筛选接受肩关节置换术的患者。排除接受翻修置换术以及有骨折、感染或恶性肿瘤病史的患者。通过在线搜索确定并核实专科培训情况。仅选择至少完成10例手术的医生；使用他们的提供者识别码在PearlDiver中进行查询。主要观察指标包括90天、1年和5年的并发症发生率和再次手术率。采用Bonferroni校正，将显著性阈值设定为P≤0.00023。
共有150385例患者符合纳入标准并纳入研究。手术趋势分析显示，随着时间的推移，接受运动医学以及肩肘专科培训的医生在所有肩关节置换术中所占比例不断增加，从2010年到2022年，每个队列分别增长了11.3%和4.2%。运动医学医生实施手术比例最高的地理区域是西部，而肩肘外科医生实施手术比例最高的是东北部。肩肘外科医生手术的患者明显更年轻且合并症更少。与完成其他类型专科培训或未接受专科培训的医生相比，肩肘外科医生和运动医学医生在90天、1年和5年时的术后并发症发生率均较低。在每个时间点，运动医学医生与肩肘外科医生之间的个体并发症发生率相当，但肩肘外科医生组的总体并发症发生率最低。
随着时间的推移，完成运动医学或肩肘专科培训的医生在肩关节置换术中所占比例越来越大。接受运动医学以及肩肘专科培训的医生在术后90天、1年和5年时的并发症发生率显著更低。运动医学医生与肩肘外科医生之间的个体并发症发生率相当，但肩肘外科医生组的总体并发症发生率最低。
