Patient Selection and Caseload for Total Hip and Knee Arthroplasty Differ Among Junior and Senior Surgeons Defining Expectations and the Value of Junior Surgeons.

Abstract

Across surgical specialties, it is generally accepted that senior surgeons can be more selective with their cases while newer surgeons tend to engage with more challenging patient profiles. By comparing the patient profiles of junior and senior total hip arthroplasty (THA) and total knee arthroplasty (TKA) surgeons, we aim to provide insight into the role of surgeon seniority in patient selection, the expected cases for a newer surgeon, and potential differences in surgical outcomes between junior and senior surgeons. We reviewed a series of 29,339 primary THA procedures and 40,450 TKA procedures from a single high-volume practice from 2016 to 2022. Patient demographics, medical comorbidities, insurance coverage, readmissions, and revisions were analyzed. Statistical analysis compared the patient profiles of three surgeon cohorts: junior surgeons with <5 years of practice, senior surgeons with 5 to 15 years of practice, and senior surgeons with >15 years of practice. A 3:1 matched subanalysis based on age, sex, body mass index, and medical comorbidities was conducted to analyze revision and readmission rates between the surgeon cohorts. Junior surgeons treated TKA and THA patients with more comorbidities than senior surgeons (P = 0.05). Junior surgeons operated on more patients with Medicare (P ≤ 0.001), patients with higher rates of impaired ambulation (P ≤ 0.001), and those who were more likely to be admitted to the hospital within the past year (P ≤ 0.001). When controlling for comorbidities, junior surgeons had no difference in the 30-day and 90-day readmissions for THA and TKA. Junior surgeons who are new to practice can expect to take on a medically challenging, higher risk, and more resource-intensive patient population. The patient selection discrepancy may explain readmission and revision rate differences between junior and senior surgeons. After matching patients based on comorbidities, junior and senior surgeons demonstrated similar 90-day outcomes.