title: The influence of patient- and surgeon-specific factors on operative duration and early postoperative outcomes in shoulder arthroplasty.
abstract: BACKGROUND
  Increased operative duration has been shown to have demonstrable effects on the outcomes and complications in multiple areas of orthopedic surgery. We sought to determine if patient- and surgeon-specific factors correlated to operative duration in shoulder arthroplasty. Our hypothesis was that increased surgeon and trainee volume would decrease operative times and that more complex pathology would increase operative duration.
  
  
  METHODS
  A retrospective review of primary and revision total and reverse shoulder arthroplasties performed at a single institution from 2012 through 2015 was performed evaluating the correlation between specific patient and surgeon factors and operative duration. The influence of operative duration on postoperative length of stay and risk of readmission within 30 days was also analyzed.
  
  
  RESULTS
  For surgeon-specific factors, high surgeon volume (>30 shoulder arthroplasties/year) was associated with shorter operative duration (105.9 vs. 128.3 minutes; P < .001). Progression through the fellowship academic year was found to be associated with decreased surgical times (100.7 vs. 116.5 minutes; P < .0001). Certain complex pathologic processes (reverse shoulder arthroplasty for sequelae of prior fracture, total shoulder arthroplasty for dysplastic glenoid morphology, revision surgery) showed increased operative times. Patients with postoperative readmission had a longer mean operative time (163 vs. 107.1 minutes).
  
  
  CONCLUSIONS
  Increased surgeon and trainee volumes were associated with decreased operative duration in shoulder arthroplasty. Patients with more complex pathology were more likely to have increased surgical times. Postoperative readmission within 30 days was associated with increased operative duration. Consideration of patient selection by surgeons to minimize operative times may reduce readmissions.
authors.affiliation: Shoulder and Elbow Surgery Service, Florida Orthopaedic Institute, Tampa, FL, USA.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Clark
authors.affiliation: Foundation for Orthopaedic Research and Education, Clinical Research, Tampa, FL, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Simon
authors.affiliation: Foundation for Orthopaedic Research and Education, Clinical Research, Tampa, FL, USA.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Clark
authors.affiliation: Foundation for Orthopaedic Research and Education, Clinical Research, Tampa, FL, USA.
authors.forename: Kaitlyn N
authors.initials: KN
authors.lastname: Christmas
authors.affiliation: Shoulder and Elbow Surgery Service, Florida Orthopaedic Institute, Tampa, FL, USA.
authors.forename: Jesse W
authors.initials: JW
authors.lastname: Allert
authors.affiliation: Shoulder and Elbow Surgery Service, Florida Orthopaedic Institute, Tampa, FL, USA.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Streit
authors.affiliation: Shoulder and Elbow Surgery Service, Florida Orthopaedic Institute, Tampa, FL, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Mighell
authors.affiliation: Hand Surgery and Microsurgery Service, Florida Orthopaedic Institute, Tampa, FL, USA.
authors.forename: Alfred
authors.initials: A
authors.lastname: Hess
authors.affiliation: Hand Surgery and Microsurgery Service, Florida Orthopaedic Institute, Tampa, FL, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Stone
authors.affiliation: Shoulder and Elbow Surgery Service, Florida Orthopaedic Institute, Tampa, FL, USA. Electronic address: mfrankle@floridaortho.com.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Frankle
mesh_terms: D000368:Aged; D000072228:Arthroplasty, Replacement, Shoulder / Q000379:methods*; D002983:Clinical Competence; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007592:Joint Diseases / Q000601:surgery*; D008297:Male; D061646:Operative Time; D010349:Patient Compliance; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011184:Postoperative Period; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000601:surgery*; D066231:Surgeons / Q000592:standards*; D013997:Time Factors
keywords: Reverse shoulder arthroplasty; complications; postoperative outcome; revision; surgeon volume; surgery; total shoulder arthroplasty