title: The effect of surgeon and hospital volume on shoulder arthroplasty perioperative quality metrics.
abstract: BACKGROUND
  There has been a significant increase in both the incidence of shoulder arthroplasty and the number of surgeons performing these procedures. Literature regarding the relationship between surgeon or hospital volume and the performance of modern shoulder arthroplasty is limited. This study examines the effect of surgeon or hospital shoulder arthroplasty volume on perioperative metrics related to shoulder hemiarthroplasty, total shoulder arthroplasty, and reverse shoulder arthroplasty. Blood loss, length of stay, and operative time were the main endpoints analyzed.
  
  
  METHODS
  Prospective data were analyzed from a multicenter shoulder arthroplasty registry; 1176 primary shoulder arthroplasty cases were analyzed. Correlation and analysis of covariance were used to examine the association between surgeon and hospital volume and perioperative metrics adjusting for age, sex, and body mass index.
  
  
  RESULTS
  Surgeon volume is inversely correlated with length of stay for hemiarthroplasty and total shoulder arthroplasty and with blood loss and operative time for all 3 procedures. Hospital volume is inversely correlated with length of stay for hemiarthroplasty, with blood loss for total and reverse shoulder arthroplasty, and with operative time for all 3 procedures. High-volume surgeons performed shoulder arthroplasty 30 to 50 minutes faster than low-volume surgeons did.
  
  
  CONCLUSIONS
  Higher surgeon and hospital case volumes led to improved perioperative metrics with all shoulder arthroplasty procedures, including reverse total shoulder arthroplasty, which has not been previously described in the literature. Surgeon volume had a larger effect on metrics than hospital volume did. This study supports the concept that complex shoulder procedures are, on average, performed more efficiently by higher volume surgeons in higher volume centers.
authors: Southern California Kaiser Permanente, San Diego, CA, USA. Electronic address: anshu_singh@hotmail.com.
authors: Anshu
authors: A
authors: Singh
authors: Southern California Kaiser Permanente, Irvine, CA, USA.
authors: Edward H
authors: EH
authors: Yian
authors: The Permanente Medical Group, Sacramento, CA, USA.
authors: Mark T
authors: MT
authors: Dillon
authors: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
authors: Miwa
authors: M
authors: Takayanagi
authors: Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA, USA.
authors: Mary F
authors: MF
authors: Burke
authors: Southern California Kaiser Permanente, Harbor City, CA, USA.
authors: Ronald A
authors: RA
authors: Navarro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000592:standards / Q000706:statistics & numerical data*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005260:Female; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007592:Joint Diseases / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data; D012785:Shoulder Joint / Q000601:surgery*
keywords: Shoulder arthroplasty; hospital volume; surgeon volume