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Patients outcomes improved with higher volume surgeons

shoulder op

Published: 23 June 2023

Patients who have shoulder replacement operations with surgeons who do over 10 of these operations a year, fare better than other patients, according to new NIHR funded and supported research. In fact, those who were operated on by high volume surgeons had a 45% lower risk of revision surgery, when compared to the lowest volume surgeons.

Researchers at the University of Oxford analysed 39,281 elective shoulder replacements from 2012 to 2020. The data was taken from the National Joint Registry and Hospital Episode Statistics in England.

The study was published in the British Medical Journal on Wednesday and supported by the NIHR Oxford Biomedical Research Centre and National Joint Registry.

It found that patients treated by higher volume surgeons showed a:

  • 53% lower risk of reoperation
  • reduction in serious adverse events (40% at 30 days and 37% at 90 days)
  • 62% reduction in the risk of a prolonged hospital stay

Epaminondas Markos Valsamis, NIHR Doctoral Research Fellow and Specialty Registrar in Trauma and Orthopaedics at the Oxford Deanery said: “Improving outcomes and reducing complications after joint replacement surgery is of clear benefit to patients and their families.

“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.”

Surgeon and hospital relationship complex

This was an observational study. Researchers say their models may be a simplification of real life practice, and models can become complicated when surgeons work at more than one hospital. They didn’t rule out that unmeasured factors may have affected their results.

Researchers added that the association between surgeons and patient outcomes is complex. As there are so many variables, they said it can be difficult to evaluate scientifically.

The statistical models investigated the effect of annual surgeon volume on:

  • revision
  • reoperation within 12 months
  • serious adverse events at 30 and 90 days,
  • and prolonged hospital stay (more than 3 nights)

Participants were aged over 18 and receiving shoulder replacement surgery for the first time.

Study to help guide future resource planning

Over 8,000 shoulder replacements take place in the UK each year. The data represented all the main types of shoulder replacement procedures. This included patients of different age, ethnicity, and socioeconomic groups.

Researchers concluded that they hoped the study would help guide future resource planning in this area.

Find out more about the study in the British Medical Journal.

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