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 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.

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.

An analysis of factors affecting the long-term results of total shoulder arthroplasty in inflammatory arthritis

1988 ◽  
Vol 3 (2) ◽  
pp. 123-130 ◽  
Author(s):  
Harry E. Figgie ◽  
Allan E. Inglis ◽  
Victor M. Goldberg ◽  
Chitranjan S. Ranawat ◽  
Mark P. Figgie ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Inflammatory Arthritis ◽  
Total Shoulder Arthroplasty ◽  
Long Term Results ◽  
Factors Affecting

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.

Single-Dose Antibiotic Regimens in Total Shoulder Arthroplasty are Safe in an Outpatient Surgery Setting

2021 ◽  
Author(s):  
Charles Fryberger ◽  
Thomas W. Throckmorton ◽  
SaeRam Oh ◽  
Jim Wan ◽  
Frederick M. Azar ◽  
...  
Keyword(s):  
Single Dose ◽  
Shoulder Arthroplasty ◽  
Outpatient Surgery ◽  
Total Shoulder Arthroplasty

scholarly journals Longer Operative Time in Elderly Patients Undergoing Posterior Lumbar Fusion Is Independently Associated With Increased Complication Rate

2018 ◽  
Vol 9 (2) ◽  
pp. 179-184 ◽  
Author(s):  
Alicia E. Hersey ◽  
Wesley M. Durand ◽  
Adam E. M. Eltorai ◽  
J. Mason DePasse ◽  
Alan H. Daniels
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Postoperative Complications ◽  
Tract Infection ◽  
Complication Rate ◽  
Operative Time ◽  
Lumbar Fusion ◽  
Improvement Program ◽  
Posterior Lumbar Fusion ◽  
Operative Duration

Study Design: Retrospective cohort study. Objective: To determine the effects of operative time on postoperative complications in patients age 65 and older undergoing posterior lumbar fusion. Methods: All patients age 65 and older undergoing posterior lumbar fusion were identified in the 2012 to 2015 American College of Surgeons National Surgical Quality Improvement Program database. The primary outcome measures were complications occurring up to 30 days postoperatively, including death, any complication, and complication subtypes. The primary independent variable was operative duration. Both bivariate and multivariate analyses utilized logistic regression and analyzed operative duration as a continuous variable. Statistical significance was considered P < .05. Results: A total of 4947 patients age 65 and older undergoing posterior lumbar fusion were identified. The mean operative time was 3.3 hours (SD 1.7). The overall complication rate was 13.4% (n = 665). In multivariate analysis, each incremental hour of operative time was associated with increased risk of postoperative thromboembolism (odds ratio [OR] = 1.23; 95% confidence interval [CI] = 1.10-1.37), transfusion (OR= 1.25; 95% CI = 1.18-1.32), urinary tract infection (OR = 1.21; 95% CI = 1.10-1.32), and total postoperative complications (OR = 1.22; 95% CI = 1.16-1.27). Conclusion: For patients age 65 and older undergoing posterior lumbar fusion, longer operative time is associated with greater risk for thromboembolism, transfusion, intubation, kidney injury, urinary tract infection, surgical site infection, and overall postoperative complications. This data highlights several specific complications that are influenced by operative time in older patients, and further supports the need for future protocols that seek to safely minimize operative time for posterior lumbar fusion.

Experimental Validation of Computer-Simulated Glenoid Preparation for Total Shoulder Arthroplasty

2011 ◽  
Author(s):  
Charlie Yongpravat ◽  
Jonathan D. Lester ◽  
Alen Trubelja ◽  
R. Michael Greiwe ◽  
Comron Saifi ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Experimental Validation ◽  
Total Shoulder Arthroplasty ◽  
Three Dimensional ◽  
Surface Preparation ◽  
The Past ◽  
Implant Placement ◽  
Operative Planning ◽  
Glenoid Surface ◽  
Glenoid Loosening

The use of three-dimensional (3D) computer simulations for pre-operative planning of total shoulder arthroplasty (TSA) has greatly increased in the past decade [1,2]. These studies have primarily focused on optimizing glenoid resurfacing to elucidate the factors involved in glenoid loosening, the most common cause of TSA failure [3,4]. While finite element analyses have investigated the effects of glenoid resurfacing parameters such as implant placement and depth of reaming on the stresses associated with the glenoid/cement/implant construct, none have determined if their method for simulating glenoid surface preparation is physically representative or accurate. In TSA, the first step in glenoid resurfacing is reaming the glenoid surface in preparation for the placement of the glenoid implant. The purpose of this study was to validate the volume removed as determined by computer simulated reaming against the volume removed by ream of cadaveric scapulae.

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