title: Surgeon experience and clinical and economic outcomes for shoulder arthroplasty.
abstract: BACKGROUND
  Previous studies have demonstrated that a high surgical volume for certain surgical procedures reduces morbidity and improves economic outcome; however, to our knowledge, no study has demonstrated a similar relationship between volume and outcome for total shoulder arthroplasty and hemiarthroplasty. The objective of this study was to determine whether increased surgeon experience was associated with improved clinical and economic outcomes for patients undergoing total shoulder arthroplasty or hemiarthroplasty.
  
  
  METHODS
  We analyzed discharge data on patients treated between 1994 and 2000 from the Maryland Health Services Cost Review Commission, which has a statewide hospital discharge database of all patients in the state of Maryland. The database included all patients undergoing total shoulder arthroplasty and hemiarthroplasty. We assessed the relationship between surgeon volume (low, medium, and high) and the risk of complications, length of stay, and total charges. The statistics were adjusted for procedure, age, gender, race, marital status, comorbidity, diagnosis, insurance type, income, and hospital volume.
  
  
  RESULTS
  For the 1868 discrete total shoulder arthroplasties and hemiarthroplasties done in the state of Maryland, the risk of at least one complication associated with the procedures done by the high-volume surgeon group was nearly half that associated with the procedures done by the low-volume surgeon group (adjusted odds ratio, 0.6; 95% confidence interval, 0.4 to 0.9). High-volume surgeons were three times more likely than were low-volume surgeons to have patients with a hospital stay of less than six days (odds ratio, 0.3; 95% confidence interval, 0.2 to 0.6). Although the average cost of hospitalization was $1000 less in the high-volume surgeon group compared with the low-volume surgeon group, this reduction did not reach significance after adjustment for multiple variables (odds ratio, 0.8; 95% confidence interval, 0.5 to 1.4).
  
  
  CONCLUSIONS
  This study indicates that the patients of surgeons with higher average annual caseloads of total shoulder arthroplasties and hemiarthroplasties have decreased complication rates and hospital lengths of stay compared with the patients of surgeons who perform fewer of these procedures. These analyses of hospital discharge data are limited because of a lack of prospective data, operative details, and patient outcomes data. However, this study emphasizes the importance of continued education for orthopaedic surgeons who perform shoulder arthroplasty.
authors.affiliation: Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Johns Hopkins University, 10753 Falls Road, Suite 215, Lutherville, MD 21093, USA.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Hammond
authors.forename: William S
authors.initials: WS
authors.lastname: Queale
authors.forename: Tae Kyun
authors.initials: TK
authors.lastname: Kim
authors.forename: Edward G
authors.initials: EG
authors.lastname: McFarland
mesh_terms: D000328:Adult; D000368:Aged; D001178:Arthroplasty / Q000191:economics* / Q000379:methods; D002983:Clinical Competence; D015331:Cohort Studies; D016001:Confidence Intervals; D003365:Costs and Cost Analysis; D005260:Female; D017722:Hospital Charges; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis / Q000191:economics* / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008396:Maryland; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D011336:Probability; D012042:Registries; D012720:Severity of Illness Index; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*