The Perioperative Impact of Surgical Case Order in Primary Total Shoulder Arthroplasty

The purpose of this study was to determine a correlation between surgical case order and the length of operative time, total length of time in the operating room, time until discharge from the hospital, and the incidence of intraoperative complications for primary total shoulder arthroplasty cases. A retrospective review was conducted of records for all individual primary total shoulder arthroplasty and reverse total shoulder arthroplasty at a single hospital. In order to compare true parameters and minimize variables, only the cases performed by one senior author were analyzed. Operative and hospital records were reviewed. There were 162 primary TSA and with the following order: 55 first order cases, 46 second order cases, 34 third order cases, 21 fourth order cases, and six fifth order cases. There were 71 primary rTSA patients included (27:27:10:6:1). Length of stay was statistically increased for both female gender (8.3%; 95% confidence interval (CI)= 0.5- 16.7%; P=0.0386) and fourth case order compared to first case (13.3%; 95% CI = 0.6%; 27.6%) P=0.041). For reverse TSA, there was no analyzed predictor that was significant. Even between anatomic TSA and reverse TSA patients, there was variability in what factors played a part in case inpatient length of stay. As such, we believe that this study highlights that case order can have an effect on operating room parameters for shoulder arthroplasty patients. The need for larger studies remains to better define that effect.