TY - JOUR
T1 - Total arthroplasty versus hemiarthroplasty for glenohumeral osteoarthritis
T2 - Role of provider volume
AU - Jain, Nitin B.
AU - Hocker, Shawn
AU - Pietrobon, Ricardo
AU - Guller, Ulrich
AU - Bathia, Neeti
AU - Higgins, Laurence D.
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2005/7
Y1 - 2005/7
N2 - The selection between total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) for the treatment of glenohumeral osteoarthritis is largely a matter of the surgeon's preference. We evaluated practice patterns among surgeons and hospitals in using shoulder arthroplasty procedures for osteoarthritis. Patients undergoing TSA (8,743 cases) and HA (4,998 cases) for osteoarthritis were extracted from the Nationwide Inpatient Sample databases. Surgeon volume and hospital volume were divided into low-, intermediate-, and high-volume categories. Multivariate logistic regression models were used to estimate the risk-adjusted association between provider volume and selection of TSA. High-volume surgeons (TSA rate, 77.2%) and intermediate-volume surgeons (TSA rate, 65.2%) were significantly more likely to perform a TSA compared with low-volume surgeons (TSA rate, 60.1%) after adjustment for confounders (P < .005). Similarly, patients admitted to high-volume hospitals were significantly more likely to undergo TSA compared with those admitted to low-volume hospitals (TSA rate, 69.9% compared with 59.5%; P < .001). In addition, procedure volume of the hospital in which the surgery was performed independently influenced a surgeon's decision to choose TSA over HA. Our study showed that high-volume providers, shown to have better outcomes after shoulder arthroplasty in previous studies, use TSA more frequently for osteoarthritis. Possible explanations may include better patient outcomes with TSA and a low-volume surgeon's comfort level in performing the more technically complex TSA procedure. Definitive treatment guidelines for glenohumeral osteoarthritis are needed.
AB - The selection between total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) for the treatment of glenohumeral osteoarthritis is largely a matter of the surgeon's preference. We evaluated practice patterns among surgeons and hospitals in using shoulder arthroplasty procedures for osteoarthritis. Patients undergoing TSA (8,743 cases) and HA (4,998 cases) for osteoarthritis were extracted from the Nationwide Inpatient Sample databases. Surgeon volume and hospital volume were divided into low-, intermediate-, and high-volume categories. Multivariate logistic regression models were used to estimate the risk-adjusted association between provider volume and selection of TSA. High-volume surgeons (TSA rate, 77.2%) and intermediate-volume surgeons (TSA rate, 65.2%) were significantly more likely to perform a TSA compared with low-volume surgeons (TSA rate, 60.1%) after adjustment for confounders (P < .005). Similarly, patients admitted to high-volume hospitals were significantly more likely to undergo TSA compared with those admitted to low-volume hospitals (TSA rate, 69.9% compared with 59.5%; P < .001). In addition, procedure volume of the hospital in which the surgery was performed independently influenced a surgeon's decision to choose TSA over HA. Our study showed that high-volume providers, shown to have better outcomes after shoulder arthroplasty in previous studies, use TSA more frequently for osteoarthritis. Possible explanations may include better patient outcomes with TSA and a low-volume surgeon's comfort level in performing the more technically complex TSA procedure. Definitive treatment guidelines for glenohumeral osteoarthritis are needed.
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U2 - 10.1016/j.jse.2004.10.007
DO - 10.1016/j.jse.2004.10.007
M3 - Article
C2 - 16015234
AN - SCOPUS:22144477909
SN - 1058-2746
VL - 14
SP - 361
EP - 367
JO - Journal of Shoulder and Elbow Surgery
JF - Journal of Shoulder and Elbow Surgery
IS - 4
ER -