Surgical conversion of shoulder and elbow conditions

Authors: Emma Torrance, Michael Walton, Puneet Monga, Adam Watts and Lennard Funk

Background: In current orthopaedic practice, the conversion rate of outpatient to surgery is a common benchmark. However there is a lack of data reporting the surgical conversion by diagnosis.  The current study presents the conversion to surgery depending on shoulder and elbow diagnoses. 

Methods: The outcome of 1176 patients at an upper limb outpatient department over a 6 month period was recorded. All patients were seen by one of four senior upper limb surgeons.  Patients had a mean age of 45.59±11.71, and consisted of 64.7% male (n=761).  Data was analysed retrospectively with regards to demographics, diagnoses and surgical intervention.  

Results: The mean surgical conversion rate for all surgeons was 14.7% (n=173).  The conversion to surgery from first appointments was 16.25% (n=117), compared to follow-up appointments at 12.28% (n=56).  The most common diagnosis of all patients was impingement, observed in 10.6% of cases (n=75) however the surgical conversion rate was low at 6.7% (n=5).  This was followed by frozen shoulder accounting for 8.5% of all diagnoses (n=60) but has only a 5% surgical conversion rate (n=3). Diagnoses with the highest surgical conversion included closed fracture of the clavicle (80%), tendon rupture of pectoralis major (50%), moderate rotator cuff tears (44.4%), labral Bankart’s tear (33.3%) and tennis elbow (33.3%).  

Conclusion: Reporting of surgical conversion rates may aid in improving current standards and allow for benchmark comparisons between different practices.  Highlighting the different conversion rates dependent on diagnoses may provide an insight into different conservative treatment options.