American Association for Hand Surgery
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Comparing the Leading Surgical Indications for Total Elbow Arthroplasty: National Trends in Case Volumes and Demographic Incidences From 2010-2018
Jacob A. Worden, BS1, Haley McKissack, MD2, Hayden L Cooke, BS2, Anthony L. Karzon, MD3, Michael B. Gottschalk, MD2 and Eric R. Wagner, MD, MS2, (1)Medical College of Georgia, Augusta, GA, (2)Emory University, Atlanta, GA, (3)Emory University School of Medicine, Atlanta, GA

Introduction: Total elbow arthroplasty (TEA) is an effective surgical intervention that can be used to treat elbow pathologies including rheumatoid arthritis, osteoarthritis, and distal humerus fractures. However, there is a paucity of literature assessing trends in the utilization of TEA. The purpose of this study was to delineate trends in TEA utilization in the United States (U.S), stratified by surgical indication, between 2010-2018.
Methods: A query of the IBM Watson Health MarketScan Database was performed to identify patients that underwent TEA from 2010-2018 using Current Procedural Terminology and International Classification of Disease coding. Patients were stratified based on surgical indication into the following groups: Distal Humerus Fracture/Post-Traumatic Sequelae, Rheumatoid Arthritis (RA), osteoarthritis (OA), and Other Indications. Population estimates from the U.S. Census Bureau were used to estimate the annual incidence and procedural trends of primary TEA for each surgical indication. Further stratification evaluated TEA based on gender, age, and geographic regions.
Results: A total of 6,522 primary TEA were performed between 2010-2018. The total volume of TEA performed during this time decreased by 33%, from 694 to 465 cases. Overall, the majority (53.9%, n = 3,514) of TEA from 2010-2018 were performed to treat distal humerus fractures/post-traumatic sequelae, while 22.3% (n = 1,457) were performed for RA, 10.8% (n = 702) for OA, and 13.0% (n = 849) for other indications. Volume and incidence of TEA decreased from 2010-2018 regardless of surgical indication, gender, and age. The greatest decreases in volume and incidence in TEA was observed for RA, by 58% and 60%, respectively. The smallest change in volume and incidence of TEA was observed for OA, with a 9% decrease in volume from 57 to 52 cases, and 14% decrease in incidence from 0.19 to 0.16 per 1,000,000 people.
Conclusions: In this study, we observed an overall decrease in the incidence and volume of primary TEA in the U.S. from 2010-2018, regardless of indication, gender, and age. Understanding the national trends of TEA utilization may provide a foundation for the direction of future studies that seek to investigate treatment algorithms for various elbow pathologies, with potential augmentation of decision-making for surgeons when selecting appropriate intervention.

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