Southern Oregon Orthopedics
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Does Surgeon Experience Affect Outcomes of Shoulder Surgery?

Does Surgeon Experience Affect Outcomes of Shoulder Surgery?
Does Surgeon Experience Affect Outcomes of Shoulder Surgery?


In recent years, there has been an increasing trend toward sub-specialization. In order to become an orthopaedic surgeon, for instance, one completes 4 years of medical school, followed by a 5 to 6 year residency program. In the past, most surgeons would then enter practice as a “generalist” and treat conditions all over the body such as foot problems, hand problems, hip problems, and shoulder problems. Over time some of these “generalists” would then develop a sub-specialty practice in which they narrowed the focus of their practice. However, it is now more common for orthopaedic surgeons to complete a fellowship beyond residency training. A fellowship is a 1-2 year period of additional training in which sub-speciality training is obtained in a specific area such as joint replacement, hand, sports medicine, spine, or shoulder.

In our group practice, we believe that fellowship training and sub-specialization has a substantial positive impact on patient outcomes. All physicians at Southern Oregon Orthopedics are required to have completed a fellowship before he or she can join our group. In fact, we are the only group in Southern Oregon and one of only a few in all of Oregon and Northern California to have this policy. Why? The answer is simple - studies across multiple specialties from general surgery to orthopaedic surgery have shown that patient outcomes are improved in the hands of a sub-specialist.

In the shoulder, for instance, this is clear with both shoulder replacement and rotator cuff repair. A study by Sherman et al, demonstrated that revision (or need for a second operation) after rotator cuff repair was lower in the hands of a surgeon who commonly performed rotator cuff repair. Similarly, complication rates after shoulder replacement have been shown to be lower in the hands of a surgeon who performs this procedure commonly. Unfortunately, the majority of shoulder replacements are performed by surgeons who perform less than 3 a year. It’s known that surgical time (the length of the operation) regardless of the type of procedure has a direct correlation with the chance of infection. Beyond about 2 hours, the chance of an infection increases substantially. Obviously a surgeon who commonly performs a procedure, with a team of assistants who are well-trained, will be able to perform a surgery more efficiently.

Patients considering shoulder surgery, or any surgery for that matter, should consider the experience of their surgeon and pay particular attention to sub-specialty (fellowship) training before deciding to proceed.