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.

Return to Sport Following Hemiarthroplasty With Concentric Reaming Versus Total Shoulder Arthroplasty: A Matched Pair Analysis

Orthopedics ◽  
2019 ◽  
Vol 42 (5) ◽  
pp. 276-284 ◽  
Author(s):  
Grant H. Garcia ◽  
Anirudh K. Gowd ◽  
Joseph N. Liu ◽  
Marissa R. Malaret ◽  
Brandon C. Cabarcas ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Return To Sport ◽  
Matched Pair ◽  
Matched Pair Analysis ◽  
Pair Analysis

scholarly journals Quantifying the Opportunity Cost of Resident Involvement in Academic Orthopaedic Sports Medicine: A Matched-Pair Analysis

2020 ◽  
Vol 36 (3) ◽  
pp. 834-841 ◽  
Author(s):  
Alexander Beletsky ◽  
Yining Lu ◽  
Brandon J. Manderle ◽  
Bhavik H. Patel ◽  
Jorge Chahla ◽  
...  
Keyword(s):  
Opportunity Cost ◽  
Sports Medicine ◽  
Matched Pair ◽  
Matched Pair Analysis ◽  
Resident Involvement ◽  
Pair Analysis

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

Does resident involvement have an impact on postoperative complications after total shoulder arthroplasty? An analysis of 1382 cases

2015 ◽  
Vol 24 (10) ◽  
pp. 1567-1573 ◽  
Author(s):  
Gregory L. Cvetanovich ◽  
William W. Schairer ◽  
Bryan D. Haughom ◽  
Gregory P. Nicholson ◽  
Anthony A. Romeo
Keyword(s):  
Postoperative Complications ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Resident Involvement

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.

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 Reverse total shoulder arthroplasty in patients with type B2, B3, and type C glenoids: comparable clinical outcome to patients without compromised glenoid bone stock—a matched pair analysis

2021 ◽  
Author(s):  
Rafael Loucas ◽  
Philipp Kriechling ◽  
Marios Loucas ◽  
Rany El Nashar ◽  
Christian Gerber ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Matched Pair ◽  
Control Group ◽  
Study Group ◽  
Bone Stock ◽  
Radiographic Outcomes ◽  
Type C ◽  
Reverse Total Shoulder

Abstract Background Primarily posterior bone deficient (dysplastic) (Walch type C) or secondarily eroded (Walch type B2 or B3) glenoids represent a surgical challenge for shoulder arthroplasty. Due to the posteriorly static decentered head, reverse total shoulder arthroplasty (RTSA) is often considered as the treatment of choice. The purpose of this study is to report the clinical and radiographic outcomes, complications and reoperations of RTSA for posteriorly deficient glenoids. Materials and methods All patients who underwent RTSA for osteoarthritis secondary to underlying glenoid deficiency (Walch type B2, B3 and C) between 2005 and 2018 (study group), were identified from our institutional shoulder arthroplasty database and gender- and age-matched to a cohort of patients with normal glenoid bone stock (control group). Longitudinal pre- and postoperative clinical [Constant–Murley (CS) score, Subjective Shoulder Value (SSV)] and radiographic outcomes were assessed. Results We included 188 patients (94 in each group). The median follow-up was 43 ± 26 (24–144) months in the study group and 59 ± 32 (24–124) months in the control group. The glenoid deficiency was addressed by using glenoid bone reconstruction. The surgical site complication and revision rate of RTSA in patients with bony deficient glenoids were 17% and 7%. Although glenoid loosening was slightly higher in the study group (5 vs. 2), overall no significant differences were found between the study and control groups in satisfaction scores, preoperative and postoperative absolute and relative Constant scores, complication and revision rates, respectively. Conclusion Reverse total shoulder arthroplasty (RTSA) seems to be a valuable treatment option for patients with primary (dysplasia) or secondary (wear) posterior glenoid deficiency. Although severe glenoid bone loss seems to be a risk factor for glenoid component failure, the overall complication and revision rates as well as clinical and radiographic outcome are comparable to RTSA in patients without compromised glenoid bone stock. Level of evidence Level III: case–control study

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
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