Surgeons who perform more shoulder replacements are more likely to significantly reduce their patients’ risk of reoperation and serious complications, according to a study published today.
Research led by the Botnar Research Centre at the University of Oxford, UK, also found that patients are also more likely to have a shorter hospital stay if they are treated by surgeons who perform an average of more than 10 shoulder surgeries a year compared to those who do fewer.
Writing in The BMJ today, the team says their findings should help guide future resource planning in this area and build on similar evidence for hip and knee replacements.
Previous studies of hip and knee replacement surgery show patients treated by “high volume” surgeons experience better outcomes than patients of lower volume surgeons, which led to some providers introducing minimum volume thresholds for surgeons.
For this study, the team analysed data from the National Joint Registry and Hospital Episode Statistics in England for 39,281 elective shoulder replacements performed by 638 consultant surgeons at 416 public and private hospitals from 2012 to 2020. All patients were over 18 years and were undergoing the surgery for the first time.
The researchers used statistical models to investigate the effect of annual surgeon volume on revision, reoperation within 12 months, serious adverse events at 30 and 90 days, and a hospital stay of three nights or more.
They identified that patients treated by surgeons who performed at least 10.4 procedures a year showed a 45% lower risk of revision surgery than those treated by surgeons who performed fewer than this.
Patients treated by higher volume surgeons also showed a 53% lower risk of reoperation, a reduction in serious adverse events and a 62% reduction in the risk of a prolonged hospital stay, although no minimum case volume threshold was identified for these outcomes.
Although these are observational findings, the team says the data used represent all the main types of shoulder replacement procedures, patients of different age, ethnicity, and socioeconomic groups, providing a complete picture of shoulder replacement activity across a national healthcare system.
They write: “Improving outcomes and reducing complications after joint replacement surgery is of clear benefit to patients and their families” and add these results “also provide timely evidence for healthcare systems that are overburdened, under-resourced, and in need of recovery planning post pandemic”.
“This study offers evidence for local hospitals and national healthcare services that informs workforce and resource planning to ensure the best outcomes for patients undergoing shoulder replacement surgery,” they add.
Valsamis EM, Collins GS, Pinedo-Villanueva R et al. Association between surgeon volume and patient outcomes after elective shoulder replacement surgery: population-based cohort study. BMJ 22 June 2023; doi: 10.1136/bmj-2023-075355
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