Disproportionate burden of septic versus aseptic revision total shoulder arthroplasty: a comparative assessment of operative time and work relative value units

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

The Bone & Joint Journal ◽

10.1302/0301-620x.101b9.bjj-2018-1369.r1 ◽

2019 ◽

Vol 101-B (9) ◽

pp. 1107-1114 ◽

Cited By ~ 3

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.

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Relative Value Units and Reimbursement for Primary and Revision Total Shoulder Arthroplasty

Seminars in Arthroplasty ◽

10.1053/j.sart.2020.11.016 ◽

2020 ◽

Author(s):

Theodore Quan ◽

Matthew J. Best ◽

Alex Gu ◽

Taylor Swansen ◽

Safa C. Fassihi ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Relative Value

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

Shoulder & Elbow ◽

10.1177/17585732211008900 ◽

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.

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

JSES Open Access ◽

10.1016/j.jses.2019.10.046 ◽

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

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

Shoulder & Elbow ◽

10.1177/1758573219876573 ◽

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.

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Primary versus revision total shoulder arthroplasty: comparing relative value and reimbursement trends

Clinics in Shoulder and Elbow ◽

10.5397/cise.2021.00458 ◽

2022 ◽

Author(s):

John Joseph Carney ◽

Erik Gerlach ◽

Mark Plantz ◽

Peter Raymond Swiatek ◽

Jeremy Marx ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Statistical Significance ◽

Total Shoulder Arthroplasty ◽

Improvement Program ◽

Surgical Time ◽

Relative Value ◽

Two Component ◽

American College Of Surgeons ◽

Component Revision ◽

Post Hoc

Background: Total shoulder arthroplasty (TSA) has been demonstrated to be an effective treatment for multiple shoulder pathologies. The purpose of our study was to compare the relative value units (RVUs) per minute of surgical time for primary and revision TSA.Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients that underwent primary TSA, one-component revision TSA, and two-component revision TSA between January 1, 2015 and December 31, 2017 using current procedure terminology codes. RVUs were divided by mean operative time for each procedure to determine the amount of revenue generated per minute. Rates were compared between the groups using a one-way analysis of variance with post-hoc Tukey test. Statistical significance was set at p<0.05.Results: When dividing compensation by surgical time, we found that two-component revision generated more compensation per minute compared to primary TSA (0.284±0.114 vs. 0.239±0.278 RVU per minute or $10.25±$4.11 vs. $8.64±$10.05 per minute, respectively; p=0.001). Conclusions: The relative value of revision TSA procedures is weighted to account for the increased technical challenges and time associated with these procedures. This study confirms that reimbursement is higher for revision TSA compared to primary TSA.

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

Shoulder & Elbow ◽

10.1177/1758573218811635 ◽

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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