Dual Surgeon Operating in Reverse Geometry Total Shoulder Replacement: The Learning Curve and Its Effects on Complication Rates

Abstract

Aims We analyse the impact of implementing dual surgeon operating for reverse geometry total shoulder replacement (RGTSR) as part of the "Getting It Right First Time" (GIRFT) recommendations in our shoulder and elbow unit, and the learning curve associated with it. Methods We performed a retrospective cohort study comparing operative time and complication rates in patients who underwent RGTSR performed by a single consultant surgeon versus two consultant surgeons over a six-year period in a single centre, in addition to an analysing the learning curve over the same period. Results A total of 74 RGTSRs were performed over a six-year period: 35 patients had a single surgeon perform their procedure and 39 had dual surgeon operating. Observed complication rates for RGTSR nearly halved following the introduction of dual surgeon operating (22.9% vs 12.8%, p=0.36). The complication rate for the first 37 cases was 9/37 (24.4%) versus 4/37 (10.8%, p=0.22) for the next 37 cases. Conclusion The implementation of dual surgeon operating may lead to reduced operative complications, provide cost savings to the hospital and produced several other non-tangible benefits to the surgeons and the department. An observed reduction in complication rates demonstrates the learning curve associated with this procedure.

Keywords: dual surgeon operating; getting it right first time; girft; learning curve; shoulder.

Figure 1. Line graph shows the number of single- and dual-surgeon reverse total shoulder replacements performed in each year from 2012 to 2017. Super-imposed bar charts show the incidence of any complications.