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The More the Better When It Comes to Shoulder Arthroplasty

Patients usually have better outcomes when they go to surgeons and hospitals with more experience doing a certain procedure. This has been studied in hip and knee replacement surgeries. Does the theory hold true for shoulder joint replacement? Shoulder replacement is a fairly rare surgery. It is also very complex. In shoulder replacement surgery, either the whole joint or half of the joint may be replaced. Replacing half of the joint is called a hemiarthroplasty.

These researchers collected data on shoulder replacements done throughout the United States over a period of 13 years. The data came from 1,000 hospitals of all types: urban and rural, large and small, public and private. Numbers were studied for complications after surgery. Complications included infections, blood clots, and poor wound healing.

The results showed that complications from shoulder replacement surgery were low overall (just over one percent). However, surgeons and hospitals with more experience had better outcomes. Surgeons who did four or fewer shoulder replacements per year, and hospitals that did 10 or fewer per year, had higher rates of problems. Patients in hospitals that did fewer shoulder replacements also stayed in the hospital up to a day longer, on average.

The differences were more significant for hemiarthroplasties. The overall rate of complications was still less than two percent in every category. But the surgeons and hospitals with less experience had over 1.5 times more complications.

This information can be important for patients. But complication rates are fairly low in all cases. It may not make that much of a difference in choosing a surgeon.

However, studies like this are of special interest to insurance companies and hospitals. Their major interest is in keeping costs down. In the big picture, making hospital stays even slightly shorter and keeping complication rates as low as possible can save a lot of money.

References: Nitin Jain, MBBS, MSPH, et al. The Relationship between Surgeon and Hospital Volume and Outcomes for Shoulder Arthroplasty. In The Journal of Bone and Joint Surgery. March 2004. Vol. 86-A. No. 3. Pp. 496-505.

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