The Impact of Arthroplasty Fellowship Training on Total Joint Arthroplasty: Comparison of Peri-Operative Metrics between Fellowship-Trained Surgeons and Non-Fellowship-Trained Surgeons |
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| Affiliation: | 1. Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN;2. MD Education Program, Indiana University School of Medicine, Indianapolis, IN;3. IU Health Physicians, Orthopedics & Sports Medicine, IU Health Hip & Knee Center, Fishers, IN;1. Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea;2. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea;3. Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea;4. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea;1. Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA;2. Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA;3. Tufts University School of Medicine, Boston, MA;4. Department of Orthopedic Surgery, Tufts Medical Center, Boston, MA |
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| Abstract: | BackgroundWe sought to identify differences between total joint arthroplasties (TJAs) performed by adult reconstruction fellowship-trained surgeons (FT) than non-fellowship-trained surgeons (NFT).MethodsA single-institution database was utilized to identify patients who underwent elective TJA between 2016 and 2019.ResultsIn total, 16,882 TJAs were identified: 9111 total hip arthroplasties (THAs) and 7771 total knee arthroplasties (TKAs). Patients undergoing THA by FT surgeons were older (63.11 vs 61.84 years, P < .001), more likely to be white, insured by Medicare, and less likely to be active smokers (P < .0001). Both surgical time (90.03 vs 113.1 minutes, P < .0001) and mean length of stay (LOS) (1.85 vs 2.72 days, P < .0001) were significantly shorter for THAs performed by FT surgeons than NFT surgeons. A significantly greater percentage of patients were discharged home after THA by FT surgeons than NFT surgeons (88.7% vs 85.2%, P = .002). FT patients were quicker to mobilize with therapy and required 25% less opioids. TKAs performed by FT surgeons were associated with shorter surgical times (87.4 vs 94.92 minutes, P < .0001), LOS (2.62 vs 2.84 days, P < .0001), and nearly 19% less opioid requirement in the peri-operative period. In addition to higher Activity Measure for Post-Acute Care scores associated with FT surgeons after TKA, a significantly greater percentage of patients were discharged home after TKA by FT surgeons than NFT surgeons (83.97% vs 80.16%, P < .001).ConclusionFor both THA and TKA, patients had significantly shorter surgical times, LOS, and required less opioids when their procedure was performed by FT surgeons compared to NTF surgeons. Patients who had their TJA performed by a FT surgeon achieved higher Activity Measure for Post-Acute Care scores and were discharged home more often than NFT surgeons. In an era of value-based care, more attention should be paid to the patient outcomes and financial implications associated with arthroplasty fellowship training.Level III EvidenceRetrospective Cohort Study. |
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| Keywords: | fellowship training outcomes value based efficiency education total joint arthroplasty |
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