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Volume Weighs Heavily on Results of Total Shoulder Replacements

What do total hip and total knee replacements, hip fractures, and total shoulder replacements have in common? Problems after surgery are less in hospitals where surgeons do high volumes of these surgeries. Patients having these operations in high-volume hospitals also stay in the hospital for fewer days. In this study the state of New York confirms this fact for total shoulder replacements.

Over 1,000 cases of total shoulder arthroplasty (TSA) were reviewed by the New York State Department of Health. They looked at length of hospital stay and costs. They also counted the number of patients brought back to the hospital within the first two months. Other measures included number of second surgeries needed within two years of the TSA and number of deaths within two months.

They found that younger patients are more likely to have surgery at high-volume hospitals. A high-volume hospital averaged 42 TSA patients each year. Hospital stay was longest in patients at low-volume hospitals. A low-volume hospital did between one and 15 TSAs each year.

The cost for TSA varied based on whether the operation was done at a low-, middle-, or high-volume hospital. The middle-volume hospitals had the lowest charges. Readmission, revision surgery, and death were lowest for high-volume hospitals.

This was the first study to show a link between increased volume of TSAs and low rate of problems after the operation. This type of study helps public health officials make policy decisions.

References: Stephen Lyman, PhD, et al. The Association Between Hospital Volume and Total Shoulder Arthroplasty Outcomes. In Clinical Orthopaedics and Related Research. March 2005. Vol. 432. Pp. 132-137.

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