Monday, October 21, 2013

Anatomic vs. reverse total shoulder arthroplasty: relative frequency of use among hospitals performing different volumes of shoulder arthroplasty

Variation in use of reverse total shoulder arthroplasty across hospitals

These authors used supply-chain data to characterize variation in the selection of anatomic versus reverse total shoulder arthroplasty across hospitals and to analyze the effect of hospital volume on this variation. The data were obtained from100 hospitals that are members of 20 integrated delivery systems in 20 states representing approximately 10% of total shoulder arthroplasties performed in the United States in 2012 (3119 vs an estimated 35,000). The total number of cases considered was 3119, of which 1580 were anatomic total shoulder arthroplasty cases and 1539. The average number of  anatomic total shoulder arthroplasty cases per hospital in this year was 15.8 and the average number of reverse total shoulder arthroplasty cases per hospital was 15.39. Total per-hospital anatomic total shoulder arthroplasty volume ranged from 0 to 87, and reverse total shoulder arthroplasty volume ranged from 0 to 172.

They found that across all hospitals, there was wide variation in the volume of total shoulder arthroplasties and the percentage of reverse shoulder arthroplasties performed. Hospitals with lower total shoulder arthroplasty volumes exhibited greater variation in the percentages of each type of total shoulder arthroplasty performed. Higher volume hospitals exhibited smaller variation. 

Comment: The fact that reverse total shoulders account for 50% of shoulder arthroplasties among these hospitals is in contrast to historical rates and not explained in the article. It would seem that either reverse total shoulders are being used in cases that previously would have had anatomic arthroplasty or that reverse total shoulder arthroplasty is being used for diagnoses (such as fractures or massive cuff tears) that previously would not have had an arthroplasty or both. In addition the use of reverse total shoulder in revision arthroplasty may also contribute to this high percentage. 

In our practice we see many patients referred to us for reverse total shoulder arthroplasty that can be better and more safely treated with anatomic total shoulder, ream and run, or CTA arthroplasty.

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