scholarly journals The Effect of Operative Time on Postoperative Outcomes in Total Shoulder Arthroplasty

2019 ◽  
Vol 3 (4) ◽  
pp. 244
Author(s):  
Jacob M. Wilson ◽  
Russell E. Holzgrefe ◽  
Christopher Staley ◽  
Spero Karas ◽  
Michael B. Gottschalk ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Operative Time ◽  
Total Shoulder Arthroplasty ◽  
Postoperative Outcomes

Impact of operative time on short-term adverse events following total shoulder arthroplasty

2020 ◽  
Vol 30 (3) ◽  
pp. 227-236
Author(s):  
Kevin I. Kashanchi ◽  
Alireza K. Nazemi ◽  
David E. Komatsu ◽  
Edward D. Wang
Keyword(s):  
Adverse Events ◽  
Shoulder Arthroplasty ◽  
Operative Time ◽  
Total Shoulder Arthroplasty ◽  
Short Term

Quantifying the Opportunity Cost of Resident Involvement in Academic Orthopedic Shoulder Arthroplasty: A Matched – Pair Analysis

2022 ◽  
pp. 175857322110654
Author(s):  
Hasani W Swindell ◽  
Alirio J deMeireles ◽  
Jack R Zhong ◽  
Elise C. Bixby ◽  
Bryan M Saltzman ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Opportunity Cost ◽  
Operative Time ◽  
Total Shoulder Arthroplasty ◽  
Laboratory Data ◽  
Matched Pair ◽  
Resident Participation ◽  
Matched Pair Analysis ◽  
Resident Involvement ◽  
Mean Differences

Background There is minimal work defining the economic impact of resident participation in shoulder arthroplasty. Thus, this study quantified the opportunity cost of resident participation in total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) by determining differences in operative time, relative value units (RVUs)/hour, and RVUs/case. Methods A retrospective analysis of shoulder arthroplasty procedures were identified from the ACS-NSQIP database from 2006 to 2014 using CPT codes. Demographic, comorbidity, preoperative laboratory data and surgical procedure were used to develop matched cohorts. Mean differences in operative time, RVUs/case and RVUs/hour between attending-only (AO) cases and cases with resident involvement (RI) were examined. Cost analysis was performed to identify differences in RVUs generated per hour in dollars/case. Results A total of 1786 AO and 1102 RI cases were identified. With the exception of PGY-3 and PGY-4 cases, RI cases had lower mean operative times compared to AO cases. The cost of RI was highest for PGY-3 ($199.87 per case) and PGY-4 ($9 .2 9) residents with all other postgraduate years providing a cost reduction. Discussion Involvement of residents was associated with shorter operative times leading to a savings of $29.64 per case. Involvement of intermediate-level (PGY-3) residents were associated with increased costs that ultimately decreased as residents became more senior.

Cemented humeral stem versus press-fit humeral stem in total shoulder arthroplasty

2019 ◽  
Vol 101-B (9) ◽  
pp. 1107-1114 ◽  
Author(s):  
M. Uy ◽  
J. Wang ◽  
N. S. Horner ◽  
A. Bedi ◽  
T. Leroux ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Operative Time ◽  
Meta Analysis ◽  
Total Shoulder Arthroplasty ◽  
A Priori ◽  
Optimal Choice ◽  
Complication Rates ◽  
Press Fit ◽  
Fixation Type

Aims The aim of this study was to evaluate the differences in revision and complication rates, functional outcomes, and radiological outcomes between cemented and press-fit humeral stems in primary anatomical total shoulder arthroplasty (TSA). Materials and Methods A comprehensive systematic review and meta-analysis was conducted searching for studies that included patients who underwent primary anatomical TSA for primary osteoarthritis or rheumatoid arthritis. Results There was a total of 36 studies with 927 cemented humeral stems and 1555 press-fit stems. The revision rate was 5.4% (95% confidence interval (CI) 3.9 to 7.4) at a mean of 89 months for cemented stems, and 2.4% (95% CI 1.1 to 4.7) at a mean of 40 months for press-fit stems. A priori subgroup analysis to control for follow-up periods demonstrated similar revision rates: 2.3% (95% CI 1.1 to 4.7) for cemented stems versus 1.8% (95% CI 1.4 to 2.9) for press-fit stems. Exploratory meta-regression found that longer follow-up was a moderating variable for revision (p = 0.003). Conclusion Cement fixation had similar revision rates when compared to press-fit stems at short- to midterm follow-up. Rotator cuff pathology was a prevalent complication in both groups but is likely not related to fixation type. Overall, with comparable revision rates, possible easier revision, and decreased operative time, humeral press-fit fixation may be an optimal choice for primary anatomical TSA in patients with sufficient bone stock. Cite this article: Bone Joint J 2019;101-B:1107–1114.

Examining the Effects of Modifiable Risk Factors on Postoperative Outcomes after Total Shoulder Arthroplasty

2021 ◽  
Author(s):  
Kamil M. Amer ◽  
Dominick V. Congiusta ◽  
Brandon Goldenberg ◽  
Jannah Chaudhry ◽  
Rami Amer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Postoperative Outcomes ◽  
Modifiable Risk Factors

scholarly journals Prospective Comparative Study of Preoperative Expectations and Postoperative Outcomes in Anatomic and Reverse Shoulder Arthroplasty

Joints ◽  
2021 ◽  
Author(s):  
Cassandra Lawrence ◽  
Mark Lazarus ◽  
Joseph Abboud ◽  
Gerald Williams ◽  
Surena Namdari
Keyword(s):  
Shoulder Arthroplasty ◽  
Functional Outcomes ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Linear Regression Analysis ◽  
Postoperative Outcomes ◽  
Consecutive Series ◽  
Multivariate Linear Regression Analysis ◽  
Significant Difference ◽  
Preoperative Expectations

Abstract Background Compared with anatomic total shoulder arthroplasty (aTSA), reverse total shoulder arthroplasty (RTSA) is associated with lower preoperative and postoperative outcome scores and range of motion. It is unknown whether patients' preoperative expectations of surgery are lower in RTSA compared with aTSA. The purpose of this study was to assess preoperative patient expectations and postoperative outcomes in aTSA and RTSA. Methods A consecutive series of patients undergoing primary aTSA for diagnosis of osteoarthritis or primary RTSA for diagnosis of rotator cuff tear arthropathy were studied prospectively. Expectations were evaluated using the validated Hospital for Special Surgery's Shoulder Surgery Expectations Survey. Baseline demographics, comorbidities, and social factors were collected. Baseline and 2 years postoperative American Shoulder and Elbow Surgeons (ASES) score, visual analog scale pain, Single Assessment Number Evaluation (SANE), and patient satisfaction were obtained. Results There were 128 patients (64 aTSA and 64 RTSA). There was no significant difference in total preoperative expectations score between groups. On multivariate linear regression analysis, aTSA (p = 0.024) and younger age (p = 0.018) were associated with higher expectations for improved ability to exercise. Changes in preoperative to postoperative ASES (p = 0.004) and SANE (p = 0.001) scores were higher in the aTSA group. Total preoperative expectations score was not correlated with postoperative functional outcomes or satisfaction in either group. In the aTSA group, expectations for participation in exercise were positively correlated with changes in preoperative to postoperative ASES score (p = 0.01) and SANE score (p = 0.01). Conclusion Though patients undergoing primary aTSA demonstrated greater improvement in functional outcome than those undergoing primary RTSA, both groups reported similar aggregate preoperative expectations. Those undergoing aTSA had higher expectations for return to exercise which was positively correlated with postoperative functional outcomes. Level of Evidence Level II, prospective cohort study.

Trends in operative duration of total shoulder arthroplasty from 2008 to 2018: a national database study

2021 ◽  
pp. 175857322110089
Author(s):  
Edward J Testa ◽  
Nicholas J Lemme ◽  
Lambert T Li ◽  
Steven DeFroda
Keyword(s):  
Shoulder Arthroplasty ◽  
Operative Time ◽  
Outpatient Surgery ◽  
Total Shoulder Arthroplasty ◽  
International Normalized Ratio ◽  
National Database ◽  
Improvement Program ◽  
Factors Affecting ◽  
Operative Duration ◽  
Operative Planning

Background As total shoulder arthroplasty has emerged as the fastest growing joint replacement performed, optimizing surgical efficiency and patient outcomes is essential. The goals of the current study were to identify trends and factors affecting the operative time of total shoulder arthroplasty over a 10-year period. Methods The National Surgical Quality Improvement Program database was analyzed to determine the operative time and 30-day complications of total shoulder arthroplasty from 2008 to 2018. Factors affecting total shoulder arthroplasty operative time were also assessed. Multivariable linear regression was used to analyze operative time over years studied while controlling for patient demographics and comorbidities. Results A total of 20,587 total shoulder arthroplasty cases from 2008 to 2018 were included. Mean operative time in 2008 was 139.0 min, while in 2018, mean operative time decreased to 105.6 min (P < .001). Male sex, outpatient surgery, increased body mass index, and low preoperative hematocrit were associated with longer operative times, while elevated international normalized ratio, resident involvement, and elective surgeries were associated with decreased operative duration. Discussion Operative time for total shoulder arthroplasty has decreased from 2008 to 2018. Patient factors and comorbidities are associated with operative time, and such factors are important to consider in operative planning to ensure appropriate patient and surgeon expectations.

scholarly journals The effect of operative time on early postoperative complications in total shoulder arthroplasty: An analysis of the ACS-NSQIP database

2019 ◽  
pp. 175857321987657
Author(s):  
Jacob M Wilson ◽  
Russell E Holzgrefe ◽  
Christopher A Staley ◽  
Spero Karas ◽  
Michael B Gottschalk ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Shoulder Arthroplasty ◽  
Operative Time ◽  
Glenohumeral Joint ◽  
Total Shoulder Arthroplasty ◽  
Provider Education ◽  
Level Of Evidence ◽  
Acs Nsqip ◽  
Increased Risk ◽  
Acs Nsqip Database

Background Total shoulder arthroplasty has been demonstrated to be an effective treatment for arthritis of the glenohumeral joint. Prior studies have identified longer operative times as a risk factor for complications after numerous types of procedures. We hypothesized that increased operative time, in 20-min intervals, would be associated with complications following total shoulder arthroplasty. Methods Patients undergoing total shoulder arthroplasty from 2006 to 2015 were identified from the ACS-NSQIP database. Patient demographic information, perioperative parameters, and 30-day outcomes were retrieved. Pearson's Chi-square test and multivariate Poisson regression with robust error variance were used to analyze the relationship of operative time and outcomes. Results A total of 10,082 patients were included. Multivariate analysis revealed that for each increase in 20 min of operative time, there were significantly increased rates of any complication (relative risk (RR) 1.24, 95% confidence interval (CI) 1.19–1.26), anemia requiring transfusion (RR 1.33, 95%CI 1.26–1.4), peripheral nerve injury (RR 1.88, 95%CI 1.53–2.31), and urinary tract infection (RR 1.24, 95%CI 1.09–1.41). Discussion This study indicates that increasing operative time confers increased risk for postoperative complications following total shoulder arthroplasty. We anticipate the results of this manuscript will be used for provider education, policy decision-making, and potentially to derive algorithms that can improve safety and efficiency in total shoulder arthroplasty. Level of evidence III.

scholarly journals Operative duration-based learning period analysis for reverse and total shoulder arthroplasty: A multicenter study

2018 ◽  
Vol 12 (1_suppl) ◽  
pp. 23-30
Author(s):  
Edward J Testa ◽  
Jeremiah T Lowe ◽  
Surena Namdari ◽  
Robert J Gillespie ◽  
Benjamin W Sears ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Operative Time ◽  
Learning Experience ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Early Career ◽  
Case Volume ◽  
Period Analysis ◽  
Operative Duration ◽  
Case Number

Background A surgical learning period may be quantified after which operative duration is significantly reduced. We sought to retrospectively quantify and compare surgeon’s learning experience for total shoulder arthroplasty and reverse shoulder arthroplasty. Methods We reviewed 2055 shoulder arthroplasty cases from 2011 to 2015 for four early-career and four later-career fellowship-trained shoulder surgeons from four institutions. We plotted consecutive case number versus operative time for each surgeon separately for total shoulder arthroplasty or reverse shoulder arthroplasty. Two-step regression approach was used to determine a plateau point or end of the learning period. Additionally, the mean annual volume of reverse shoulder arthroplasty and total shoulder arthroplasty for each surgeon was plotted against mean surgery duration. Early- and later-career surgeons were compared with regression analysis. Results Early-career surgeons demonstrated a significant decrease in operative time with increasing annual case volume for reverse shoulder arthroplasty ( p = 0.01; m = −1.1) and total shoulder arthroplasty ( p = 0.02; m = −0.8). Three of four early-career surgeons reached a plateau point for either reverse shoulder arthroplasty or total shoulder arthroplasty between 12 and 86 cases. Conclusion For only early-career surgeons, higher case volume yields decreased operative duration, with improvement more pronounced for reverse shoulder arthroplasty compared to total shoulder arthroplasty. Though the learning period varies, it may be fewer than 90 cases.

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