Trends in Open Shoulder Surgery Among Early Career Orthopaedic Surgeons: Who is Doing What?
Daniel P. Carpenter, MD, (Doctor of Medicine) Clinical Fellow, Shawn D. Feinstein, MD, (Doctor of Medicine) Resident Physician, Eric D. Van Buren, BS, (Bachelor of Science) Doctoral Candidate, Feng-Chang Lin, PhD, (Doctoral Degree) Research Associate Professor, Annunziato N. Amendola, MD, (Doctor of Medicine) Professor and Vice Chair, Robert A. Creighton, MD, (Doctor of Medicine) Clinical Professor, and Ganesh V. Kamath, MD, (Doctor of Medicine) Associate Clinical ProfessorElbow Shoulder
Background:
The incidence of various open shoulder procedures has changed over time. Additionally, 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 (ABOS) Part-II database was queried from 2002–2016 for reported open shoulder procedures. 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 five 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 (OR, 0.76; 95% CI, 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 five or more arthroplasty cases (OR, 0.81; 95% CI, 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.
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