The impact of surgeon volume on subscapularis repair and postoperative management following reverse shoulder arthroplasty

Abstract

BackgroundReverse shoulder arthroplasty (RSA) recognition and acceptance is growing as patients report improved pain and function. Therefore, it is crucial to identify and modify factors that affect outcomes, some of the current aspects under discussion are subscapularis (SSc) management and postoperative rehabilitation (rehab) protocols. Our study seeks to evaluate the practices of American Shoulder and Elbow Surgeons members in managing the SSc during surgery and determining the best approach for postoperative rehab after RSA. MethodsAn eight-question survey was distributed to 1217 members of the American Shoulder and Elbow Surgeons, inquiring about SSc management and rehab practices following RSA. The survey included multiple-choice questions that evaluated characteristics of surgeon’s approach to rehab and perspectives of formal supervised outpatient therapy programs. The cohort was divided based on yearly RSA case volume and whether SSc is routinely repaired during RSA. ResultsMore than one third of surgeons (35.3%) reported ordering formal rehab due to patient expectations, but did not believe it was critical, and only 8.9% believed formal rehab to be critical in the recovery of patient strength. Almost two thirds (60.7%) of surgeons did not place a limitation on internal rotation. Of the 72.3% of surgeons that repaired the SSc, 49.7% restrict external rotation. When separating the cohort based on surgical volume, surgeons who performed more than 100 cases were significantly more likely to immobilize patients for more than 4 weeks postoperatively (P = .041). Surgeons who repaired the SSc were significantly more likely to immobilize patients for more than 4 weeks compared to surgeons who did not repair SSc (P < .001). ConclusionManagement of the SSc and surgeon case volume are critical factors in postoperative rehab after RSA. The majority of surgeons tend to repair the SSc, while only half of those that repair it immobilize it after surgery. Further studies that better evaluate the impact of postoperative immobilization on patient reported outcomes and satisfaction scores are needed in order to develop a more standardized approach and definitive guidelines.