Total arthroplasty versus hemiarthroplasty for glenohumeral osteoarthritis: role of provider volume.
The selection between total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) for the treatment of glenohumeral osteoarthritis is largely a matter of the surgeon's preference. We evaluated practice patterns among surgeons and hospitals in using shoulder arthroplasty procedures for osteoarthritis. Patients undergoing TSA (8,743 cases) and HA (4,998 cases) for osteoarthritis were extracted from the Nationwide Inpatient Sample databases. Surgeon volume and hospital volume were divided into low-, intermediate-, and high-volume categories. Multivariate logistic regression models were used to estimate the risk-adjusted association between provider volume and selection of TSA. High-volume surgeons (TSA rate, 77.2%) and intermediate-volume surgeons (TSA rate, 65.2%) were significantly more likely to perform a TSA compared with low-volume surgeons (TSA rate, 60.1%) after adjustment for confounders (P < .005). Similarly, patients admitted to high-volume hospitals were significantly more likely to undergo TSA compared with those admitted to low-volume hospitals (TSA rate, 69.9% compared with 59.5%; P < .001). In addition, procedure volume of the hospital in which the surgery was performed independently influenced a surgeon's decision to choose TSA over HA. Our study showed that high-volume providers, shown to have better outcomes after shoulder arthroplasty in previous studies, use TSA more frequently for osteoarthritis. Possible explanations may include better patient outcomes with TSA and a low-volume surgeon's comfort level in performing the more technically complex TSA procedure. Definitive treatment guidelines for glenohumeral osteoarthritis are needed.
Jain
Nitin B
NB
Center for Excellence in Surgical Outcomes, Durham, NC, USA. nitin_jain@hms.harvard.edu
Hocker
Shawn
S
Pietrobon
Ricardo
R
Guller
Ulrich
U
Bathia
Neeti
N
Higgins
Laurence D
LD
D000368:Aged; D019643:Arthroplasty, Replacement / Q000379:methods*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010003:Osteoarthritis / Q000601:surgery*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012785:Shoulder Joint / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome