Hospital Volume Predicts Outcomes and Complications after Total Shoulder Arthroplasty in the United States.
Objective: To assess the association of hospital procedure volume for total shoulder arthroplasty (TSA) with patient outcomes and complications. Methods: We used the U.S. Nationwide Inpatient Sample (NIS) from 1998-2011 to study the association of hospital annual TSA procedure volume with patient characteristics and TSA outcomes, including discharge disposition (home vs. inpatient facility), length of index hospitalization, post-arthroplasty periprosthetic fracture and revision. Annual hospital TSA volume was categorized as <5, 5-9, 10-14, 15-24 and ?25 TSA procedures annually. Results: Patients receiving TSA at higher volume hospitals were more likely to be female (p<0.0001) and White (p<0.0001). Compared to low volume hospitals (<5, 5-9, 10-14 procedures annually), patients receiving TSA at higher volume hospitals (15-24, ?25) had significantly lower likelihood of: (1) being discharged to an inpatient medical facility, 16.5%, 13.4%, 13.0%, 12.7% and 11.5% (p<0.0001); (2) hospital stay >median, 46.6%, 40.4%, 36.6%, 34.4% and 29.2% (p<0.0001); (3) post-arthroplasty fracture, 1.2%, 0.8%, 0.9%, 0.6% and 0.8% (p=0.0004); (4) blood transfusion, 8%, 7.1%, 6.7%, 7.1% and 5.5% (p=0.006); and (5) TSA revision, 0.5%, 0.3%, 0.2%, 0.3%, 0.3% (p=0.045), respectively. Conclusions: In this study, we found that higher annual hospital TSA volume was associated with better TSA outcomes in the U.S. These findings document the impact of annual hospital TSA volume on TSA outcomes. Patients, surgeons and policy-makers should be aware of these findings and take them into account in decision-making, policy decisions and resource allocation. © 2014 American College of Rheumatology.