Higher volume surgeons have lower one-year post-operative cost after total shoulder arthroplasty

The relationship between total shoulder arthroplasty (TSA) volume and overall postoperative cost is unclear. The purpose of this study is to assess the impact of surgeon volume on total 1-year postoperative costs. An observational cohort study was performed utilizing Marketscan databases. Patients undergoing inpatient TSAs between January 1st, 2017 and December 31st, 2019 were included. Patients with ICD-10 Diagnosis codes of trauma, fracture, or shoulder cancer were excluded. Surgeon volume was calculated as the maximum annual volume between 2017 and 2018. The primary outcome was total 1-year postoperative costs, including revision and nonoperative costs. Secondary outcomes were rates of revision and nonoperative procedures. The analyzed study population consisted of 2,216 patients from 1,255 surgeons. Patients operated on by high-volume surgeons were more likely to be older, live in the Northeast and/or metropolitan area, and to have a reverse TSA performed. Total 1-year postoperative costs were lower for high-volume surgeons with an inverse relationship with surgeon volume (high:$1,925 medium:$1,715, low:$1,193, P<.001). Physical therapy rates (high: 76.7%, medium: 82.0%, low: 86.6%, P<.001) and costs (high:$1,223, medium: $1,655, low: $1,870, P< .001) were lowest for high-volume surgeons. High-volume surgeons were associated with lower 1-year postoperative costs with revisions and PT as the main driver of these costs. These improved outcomes may reflect surgeon skill and experience. Further research is necessary to establish standardized guidelines for postoperative PT regimen.