In view of concern about rising health care costs, these authors assessed factors that were associated with lower hospital costs and variations in surgical treatment for proximal humeral fractures. They used national databases for 2001 to 2008 to extract information on 25,731 patients undergoing surgery for proximal humeral fractures.
They found that higher surgeon volume, open reduction and internal fixation (versus hemiarthroplasty), and lower burden of comorbidities were associated with lower hospital cost.
Adjusting for all other factors, higher surgeon volume was linearly associated with lower hospital costs such that a surgeon performing 20 shoulder arthroplasties per year saves a hospital approximately US $1800 per surgery.
High surgeon volume and earlier years of the study period were associated with higher utilization of hemiarthroplasty in the treatment of fractures.
Surgeons with high procedure volume had lower in hospital mortality rates (0.2%) and lower length of stay than surgeons with low procedure volume (0.6%). Their length of stay was 3.4 days versus 5.5 days for low volume surgeons,
This volume effect may reflect the role of experience in patient selection, surgical technique, and postoperative care
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