Trends in open shoulder surgery among early career orthopedic surgeons: who is doing what?

The incidence of various open shoulder procedures has changed over time. In addition, various fellowships provide overlapping training in open shoulder surgery. There is a lack of information regarding the relationship between surgeon training and open shoulder procedure type and incidence in early...

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Bibliographic Details
Published in:	Journal of shoulder and elbow surgery Vol. 29; no. 7; pp. e269 - e278
Main Authors:	Carpenter, Daniel P., Feinstein, Shawn D., Van Buren, Eric D., Lin, Feng-Chang, Amendola, Annunziato N., Creighton, Robert A., Kamath, Ganesh V.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-07-2020
Subjects:	ABOS Arthroplasty - statistics & numerical data Clinical Competence complications Databases, Factual fellowship Fellowships and Scholarships - statistics & numerical data Humans Joint Instability - surgery open Orthopedic Procedures - trends Orthopedic Surgeons - education Orthopedic Surgeons - statistics & numerical data Orthopedic Surgeons - trends Orthopedics - statistics & numerical data Orthopedics - trends Reoperation - statistics & numerical data Rotator Cuff Injuries - surgery shoulder Shoulder Joint - surgery training trends United States United States Epidemiology Study complications Large Database Analysis training ABOS fellowship shoulder open trends
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Summary:	The incidence of various open shoulder procedures has changed over time. In addition, various fellowships provide overlapping training in open shoulder surgery. There is a lack of information regarding the relationship between surgeon training and open shoulder procedure type and incidence in early career orthopedic surgeons. The American Board of Orthopaedic Surgery Part-II database was queried from 2002 to 2016 for reported open shoulder procedures. The procedures were categorized as follows: arthroplasty, revision arthroplasty, open instability, trauma, and open rotator cuff. We evaluated procedure trends as well as their relationship to surgeon fellowship categorized by Sports, Shoulder/Elbow, Hand, Trauma, and “Other” fellowship as well as no fellowship training. We additionally evaluated complication data as it related to procedure, fellowship category, and volume. Over the 2002-2016 study period, there were increasing cases of arthroplasty, revision arthroplasty, and trauma (P < .001). There were decreasing cases in open instability and open rotator cuff (P < .001). Those with Sports training reported the largest overall share of open shoulder cases. Those with Shoulder/Elbow training reported an increasing overall share of arthroplasty cases and higher per candidate case numbers. The percentage of early career orthopedic surgeons reporting 5 or more arthroplasty cases was highest among Shoulder/Elbow candidates (P < .001). Across all procedures, those without fellowship training were least likely to report a complication (odds ratio [OR], 0.76; 95% confidence interval, 0.67-0.86; P < .001). Shoulder/Elbow candidates were least likely to report an arthroplasty complication (OR, 0.84, P = .03) as was any surgeon reporting 5 or more arthroplasty cases (OR, 0.81; 95% confidence interval, 0.70-0.94; P = .006). The type and incidence of open shoulder surgery procedures continues to change. Among early career surgeons, those with more specific shoulder training are now performing the majority of arthroplasty-related procedures, and early career volume inversely correlates with complications.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1058-2746 1532-6500
DOI:	10.1016/j.jse.2020.01.075