Purpose
To examine surgical complications, length of stay, surgical time, cost, revision rates,
clinical outcomes, current surgical trends. and minimum number of cases in relationship
to surgeon volume for shoulder arthroplasty and rotator cuff repair.
Methods
We performed a systematic review of studies using the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses guidelines. All studies that met inclusion criteria
from January 1990 to January 2016 were included. Inclusion criteria included Level
IV evidence or greater, contained specific surgeon volume, and were written in or
translated into English. Exclusion criteria included non-English manuscripts, abstracts,
and review papers. A written protocol was used to extract relevant data and evaluate
study results. Data extracted included volume-specific data pertaining to length of
stay, operating time, complications, and cost.
Results
A total of 10 studies were included. Seven studies evaluated arthroplasty with 88,740
shoulders, and 3 studies evaluated rotator cuff repair with 63,535 shoulders. Variation
was seen in how studies defined low- versus high-volume surgeon. For arthroplasty,
<5 cases per year met the criteria for a low-volume surgeon and were associated with
increased length of stay, longer operating room time, increased in-hospital complications,
and increased cost. Mortality was not significantly increased. In rotator cuff surgery,
<12 surgeries per year met the criteria for low volume and were associated with increased
length of stay, increased operating room time, and increase in reoperation rate.
Conclusions
Our systematic review demonstrates increased surgical complications, length of stay,
surgical time, and surgical cost in shoulder arthroplasty and rotator cuff repair
when performed by a low-volume shoulder surgeon, which is defined by those performing
<5 arthroplasties and/or <12 rotator cuff repairs per year.
Level of Evidence
Level III, systematic review of Level II and III studies.
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Article info
Publication history
Published online: April 26, 2017
Accepted:
March 2,
2017
Received:
August 19,
2016
Footnotes
See commentary on page 1282
The authors report the following potential conflicts of interest or sources of funding: A.D. received support from Arthroscopy, Smith & Nephew, BioMet, Penn State Hershey Medical Center, the Orthopaedic Research and Education Foundation, and the National Institutes of Health.
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© 2017 by the Arthroscopy Association of North America
