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. 2020 Jul;29(7):e269-e278.
doi: 10.1016/j.jse.2020.01.075. Epub 2020 Apr 24.

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

Daniel P Carpenter  1 , Shawn D Feinstein  2 , Eric D Van Buren  3 , Feng-Chang Lin  3 , Annunziato N Amendola  4 , Robert A Creighton  5 , Ganesh V Kamath  5
Affiliations

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

Daniel P Carpenter et al. J Shoulder Elbow Surg. 2020 Jul.

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords: ABOS; complications; fellowship; open; shoulder; training; trends.

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Figures

Figure 1.
Figure 1.
Case trends from 2002–2016 for general procedure categories for open shoulder surgery among early career orthopedic surgeons.
Figure 2.
Figure 2.
Average number of open shoulder cases reported during the 2009–2016 study period by fellowship type. *Per candidate average is among those reporting at least one open shoulder procedure.
Figure 3.
Figure 3.
Total share of arthroplasty procedure by fellowship type. Those with Sports training reported the largest share at the beginning of the study period and those with Shoulder/Elbow training reported the largest share at the end of the study period.
Figure 4.
Figure 4.
Average arthroplasty cases per candidate from the three fellowship categories reporting the highest share or arthroplasty cases (Shoulder/Elbow, Sports, and Hand). Shoulder/Elbow reported the highest per candidate across all years (P <.001) and increases were seen in both Shoulder/Elbow and Hand per candidate averages (P <.001) but no change in Sports (P= .173). These mean case numbers are for candidates reporting at least one case, not across the entire group of fellowship candidates.
Figure 5.
Figure 5.
Trends from 2002–2016 comparing open versus arthroscopic instability surgery. The open instability category is further stratified by bone block/Laterjet and open soft tissue procedures.
Figure 6.
Figure 6.
Total share of open shoulder trauma by fellowship category.
Figure 7.
Figure 7.
Trends from 2002–2016 comparing open versus arthroscopic rotator cuff procedures.
See this image and copyright information in PMC

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