title: Does hospital volume predict outcomes and complications after total shoulder arthroplasty in the US?
abstract: OBJECTIVE
  To assess the association of hospital procedure volume for total shoulder arthroplasty (TSA) with patient outcomes and complications.
  
  
  METHODS
  We used the US Nationwide Inpatient Sample from 1998-2011 to study the association of hospital annual TSA procedure volume with patient characteristics and TSA outcomes, including discharge disposition (home versus inpatient facility), length of index hospitalization, postarthroplasty periprosthetic fracture, and revision. Annual hospital TSA volume was categorized as <5, 5-9, 10-14, 15-24, and ≥25 TSA procedures annually.
  
  
  RESULTS
  Patients receiving TSA at higher volume hospitals were more likely to be female (P < 0.0001) and white (P < 0.0001). Compared to low volume hospitals (<5, 5-9, or 10-14 procedures annually), patients receiving TSA at higher volume hospitals (15-24 or ≥25 procedures annually) had significantly lower likelihood of being discharged to an inpatient medical facility: 16.5%, 13.4%, 13.0%, 12.7%, and 11.5%, respectively (P < 0.0001); hospital stay above the overall median: 46.6%, 40.4%, 36.6%, 34.4%, and 29.2%, respectively (P < 0.0001); postarthroplasty fracture: 1.2%, 0.8%, 0.9%, 0.6%, and 0.8%, respectively (P = 0.0004); blood transfusion: 8%, 7.1%, 6.7%, 7.1%, and 5.5%, respectively (P = 0.006); and TSA revision: 0.5%, 0.3%, 0.2%, 0.3%, 0.3%, respectively (P = 0.045).
  
  
  CONCLUSIONS
  In this study, we found that higher annual hospital TSA volume was associated with better TSA outcomes in the US. These findings document the impact of annual hospital TSA volume on TSA outcomes. Patients, surgeons, and policy-makers should be aware of these findings and take them into account in decision-making, policy decisions, and resource allocation.
authors.affiliation: Birmingham VA Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Jasvinder A
authors.initials: JA
authors.lastname: Singh
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Rekha
authors.initials: R
authors.lastname: Ramachandran
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D016208:Databases, Factual; D005260:Female; D006301:Health Services Needs and Demand; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D044469:Racial Groups; D012086:Reoperation; D012307:Risk Factors; D012737:Sex Factors; D012785:Shoulder Joint / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States