Tuesday, January 10, 2017

Increasing demand for shoulder arthroplasty, how should it be managed?

Yearly Trends in Elective Shoulder Arthroplasty, 2005 through 2013

These authors evaluated the (1) change in incidence rate of shoulder arthroplasty, the (2) utilization of shoulder arthroplasty for specific indications, and the (3) surgeon volume trends associated with these procedures between 2005 and 2013 in the Kaiser integrated healthcare system in California.

The incidence of shoulder arthroplasty per 100,000 members increased from 6.1 in 2005 to 13.4 in 2013. In patients with osteoarthritis, there was increasing utilization of total shoulder arthroplasty and decreasing utilization of hemiarthroplasty. For patients with rotator cuff tear arthropathy, there was an increase in utilization of reverse total shoulder arthroplasty but no change in hemiarthroplasty. The average surgeon yearly volume increased for total shoulder arthroplasty and reverse total shoulder arthroplasty.

Greater case demand is not being met with more surgeons performing shoulder arthroplasty, but rather with an increase in the yearly volume of shoulder arthroplasties performed per surgeon.

Over the period of the study, the number of surgeons in the health plan performing shoulder arthroplasty diminished slightly.

As a result the number of shoulder arthroplasties per shoulder arthroplasty surgeon increased.

The trends demonstrated in this study are likely to lead to improved quality of patient care: the relationship between surgeon volume and outcome is well recognized. See this related post that suggests that 11 shoulder arthroplasties/year might be used as the definition of a 'high volume' arthroplasty surgeon:

What is a 'high volume' shoulder arthroplasty surgeon and where are they?


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