title: Variation in use of reverse total shoulder arthroplasty across hospitals.
abstract: BACKGROUND
  The opportunity for variation exists in the choice between anatomic and reverse total shoulder arthroplasty. Quality improvement methods seek to reduce variation. We used supply-chain data to characterize variation in the selection of anatomic versus reverse total shoulder arthroplasty across hospitals and to analyze the effect of hospital volume on this variation.
  
  
  METHODS
  Mendenhall Associates, Inc (Ann Arbor, MI, USA) provided us with a database of hospital supply-chain data from orthopaedic surgical cases. This study included hospitals in which at least one total shoulder arthroplasty was performed. We calculated, for each hospital, the percentages of each type of prosthesis implanted and examined the distribution of these percentages across all hospitals. We also divided the sample of hospitals into tertiles, by volume of total shoulder arthroplasties performed, and examined the distributions of percentage reverse shoulder arthroplasty performed in each tertile.
  
  
  RESULTS
  Across all hospitals, we saw wide variation in the volume of total shoulder arthroplasties and the percentage of reverse shoulder arthroplasties performed. Hospitals with lower total shoulder arthroplasty volumes exhibited greater variation in the percentages of each type of total shoulder arthroplasty performed. Higher volume hospitals exhibited smaller variation.
  
  
  CONCLUSIONS
  This study revealed wide variation in the selection of anatomic and reverse total shoulder arthroplasty across all hospitals and an inverse relationship between hospital volume and variation. This variation signals uncertainty about the best application of each device and that there is need for improvement in the consistency of treatment of patients with shoulder disease.
  
  
  METHODS
  Level II, cost-effectiveness study, economic and decision analysis.
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Boguski
authors.forename: Bruce S
authors.initials: BS
authors.lastname: Miller
authors.forename: James E
authors.initials: JE
authors.lastname: Carpenter
authors.forename: Stanley
authors.initials: S
authors.lastname: Mendenhall
authors.forename: Richard E
authors.initials: RE
authors.lastname: Hughes
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000379:methods* / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012785:Shoulder Joint / Q000601:surgery; D016896:Treatment Outcome
keywords: Cost-Effectiveness Study; Economic and Decision Analysis; Level II; Shoulder arthroplasty; hospitals; prostheses; quality; reverse total shoulder arthroplasty; supply chain