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

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.

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Continued Inpatient Care After Primary Total Shoulder Arthroplasty Is Associated With Increased Short-term Postdischarge Morbidity: A Propensity Score–Adjusted Analysis

Orthopedics ◽

10.3928/01477447-20190125-02 ◽

2019 ◽

Vol 42 (2) ◽

pp. e225-e231 ◽

Cited By ~ 3

Author(s):

John M. Apostolakos ◽

Venkat Boddapati ◽

Michael C. Fu ◽

Brandon J. Erickson ◽

David M. Dines ◽

...

Keyword(s):

Propensity Score ◽

Shoulder Arthroplasty ◽

Inpatient Care ◽

Total Shoulder Arthroplasty ◽

Short Term ◽

Adjusted Analysis

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Short term results of reverse total shoulder arthroplasty

Journal of Clinical Orthopaedics and Trauma ◽

10.1016/j.jcot.2019.08.008 ◽

2020 ◽

Vol 11 ◽

pp. S270-S274

Author(s):

Aditya K. Agrawal ◽

Carlos Wigderowitz ◽

Bruno Ribeiro ◽

Amar Malhas ◽

Abhishek Vaish ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Short Term ◽

Reverse Total Shoulder

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Short-term outcomes after anatomic total shoulder arthroplasty in patients with osteoarthritis versus osteonecrosis

Annals of Translational Medicine ◽

10.21037/atm.2018.12.63 ◽

2019 ◽

Vol 7 (3) ◽

pp. 48-48

Author(s):

Sergio M. Navarro ◽

Heather S. Haeberle ◽

Anton Khlopas ◽

Jared M. Newman ◽

Jaret M. Karnuta ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Short Term

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CORR Insights®: Obesity is Not Associated with Increased Short-term Complications After Primary Total Shoulder Arthroplasty

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-015-4618-x ◽

2015 ◽

Vol 474 (3) ◽

pp. 796-798

Author(s):

R. Michael Gross

Keyword(s):

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Short Term

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Efficacy of Magnetic Sphincter Augmentation versus Nissen Fundoplication for Gastroesophageal Reflux Disease in Short Term: A Meta-Analysis

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2017/9596342 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Ming-yu Chen ◽

Di-yu Huang ◽

Angela Wu ◽

Yi-bin Zhu ◽

He-pan Zhu ◽

...

Keyword(s):

Gastroesophageal Reflux Disease ◽

Proton Pump Inhibitor ◽

Gastroesophageal Reflux ◽

Adverse Events ◽

Proton Pump ◽

Reflux Disease ◽

Operative Time ◽

Meta Analysis ◽

Magnetic Sphincter Augmentation ◽

Short Term

Background. The efficacy of Magnetic Sphincter Augmentation (MSA) and its outcomes for Gastroesophageal Reflux Disease (GERD) are uncertain. Therefore, we aimed to summarize and analyze the efficacy of two treatments for GERD.Methods. The meta-analysis search was performed, using four databases. All studies from 2005 to 2016 were included. Pooled effect was calculated using either the fixed or random effects model.Results. A total of 4 trials included 624 patients and aimed to evaluate the differences in proton-pump inhibitor use, complications, and adverse events. MSA had a shorter operative time (MSA and NF: RR = −18.80, 95% CI: −24.57 to −13.04, andP=0.001) and length of stay (RR = −14.21, 95% CI: −24.18 to −4.23, andP=0.005). Similar proton-pump inhibitor use, complication (P=0.19), and severe dysphagia for dilation were shown in both groups. Although there is no difference between the MSA and NF in the number of adverse events, the incidence of postoperative gas or bloating (RR = 0.71, 95% CI: 0.54–0.94, andP=0.02) showed significantly different results. However, there is no significant difference in ability to belch and ability to vomit.Conclusions. MSA can be recommended as an alternative treatment for GERD according to their short-term studies, especially in main-features of gas-bloating, due to shorter operative time and less complication of gas or bloating.

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Risk factors for and timing of adverse events after revision total shoulder arthroplasty

Shoulder & Elbow ◽

10.1177/1758573218780517 ◽

2018 ◽

Vol 11 (5) ◽

pp. 332-343 ◽

Cited By ~ 1

Author(s):

Aakash Keswani ◽

Debbie Chi ◽

Andrew J Lovy ◽

Daniel A London ◽

Paul J Cagle ◽

...

Keyword(s):

Risk Factors ◽

Adverse Events ◽

Shoulder Arthroplasty ◽

Perioperative Complications ◽

Total Shoulder Arthroplasty ◽

Significant Risk ◽

Significant Risk Factor ◽

Perioperative Outcomes ◽

Unplanned Readmission ◽

Acs Nsqip Database

Background Despite increasing rates of revision total shoulder arthroplasty (RTSA), there is a paucity of literature on optimizing perioperative outcomes. The purposes of this study were to identify risk factors for unplanned readmission and perioperative complications following RTSA, risk-stratify patients based on these risk factors, and assess timing of complications. Methods Bivariate and multivariate analyses of risk factors were assessed on RTSA patients from the ACS-NSQIP database from 2011 to 2015. Patients were risk-stratified and timing of severe adverse events and cause of readmission were evaluated. Results Of 809 RTSA patients, 61 suffered a perioperative complication or readmission within 30 days of discharge. Multivariate analysis identified operative time, BMI > 40, infection etiology, high white blood cell count, and low hematocrit as significant independent risk factors for 30-day complications or readmission after RTSA (p ≤ 0.05). Having at least one significant risk factor was associated with 2.71 times risk of complication or readmission within 15 days compared to having no risk factors (p < 0.001). The majority of unplanned readmission, return to the operating room, open/deep wound infection, and sepsis/septic shock occurred within two weeks of RTSA. Discussion Patients at high risk of complications and readmission after RTSA should be identified and optimized preoperatively to improve outcomes and lower costs.

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Comparison of surgical and non-surgical treatments for 3- and 4-part proximal humerus fractures: A network meta-analysis

Shoulder & Elbow ◽

10.1177/1758573219831506 ◽

2019 ◽

Vol 12 (2) ◽

pp. 99-108 ◽

Cited By ~ 1

Author(s):

Sebastian Orman ◽

Amin Mohamadi ◽

Joseph Serino ◽

Jordan Murphy ◽

Philip Hanna ◽

...

Keyword(s):

Surgical Treatment ◽

Adverse Events ◽

Shoulder Arthroplasty ◽

Open Reduction ◽

Proximal Humerus ◽

Total Shoulder Arthroplasty ◽

Open Reduction Internal Fixation ◽

Reverse Total Shoulder Arthroplasty ◽

Reverse Total Shoulder ◽

Non Surgical Treatment

Introduction Common treatment strategies for proximal humerus fractures include non-surgical treatment, open reduction internal fixation, hemiarthroplasty, and reverse total shoulder arthroplasty. There is currently no consensus regarding the superiority of any one surgical strategy. We used network meta-analysis of randomized controlled trials to determine the most successful treatment for proximal humerus fractures. Methods MEDLINE, EMBASE, Web of Science, and Cochrane Central electronic databases were searched for randomized controlled trials comparing 3- and 4-part proximal humerus fracture treatments. Data extraction included the mean and standard deviation of clinical outcomes (Constant, DASH), adverse events, and additional surgery rates. Standard Mean Difference was used to compare clinical outcome scores, and pooled risk ratios were used to compare adverse events and additional surgeries. Results Eight randomized controlled trials were included for network meta-analysis. Non-surgical treatment was associated with a lower rate of additional surgery and adverse events compared to open reduction internal fixation. Reverse total shoulder arthroplasty resulted in fewer adverse events and a better clinical outcome score than hemiarthroplasty. Non-surgical treatment produced similar clinical scores, adverse event rates, and additional surgery rates to hemiarthroplasty and reverse total shoulder arthroplasty. Conclusion Non-surgical treatment results in fewer complications and additional surgeries compared to open reduction internal fixation. Preliminary data supports reverse total shoulder arthroplasty over hemiarthroplasty, but more evidence is needed to strengthen this conclusion.

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