{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T14:17:50Z","timestamp":1765808270713,"version":"3.40.5"},"reference-count":26,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,9,3]],"date-time":"2023-09-03T00:00:00Z","timestamp":1693699200000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Australian healthcare relies on both private and public sectors to meet the demand for surgical care. Rapid growth of shoulder replacement surgery highlights a disparity in service provision, with two\u2010thirds occurring privately. This study aimed to assess the influence of hospital setting on shoulder replacement revision rate at a national level.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All primary shoulder replacements recorded by the Australian Orthopaedic Association National Joint Replacement Registry from April 2004 to December 2020 were included. Private and public settings were compared for stemmed total shoulder replacement (sTSR) for osteoarthritis (OA), reverse total shoulder replacement (rTSR) for OA\/cuff arthropathy (CA), and rTSR for fracture. The primary outcome was cumulative percent revision (CPR), with Kaplan\u2013Meier estimates of survivorship to determine differences between private and public hospitals, recorded as hazard ratios (HR). Secondary analyses investigated differences between hospital settings, targeting hospital outliers for revision and prosthesis selection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Primary sTSR (OA) demonstrated a higher revision rate in private hospitals compared to public hospitals (HR\u2009=\u20091.27; <jats:italic>P<\/jats:italic>\u2009=\u20090.001), as did rTSR (OA\/CA) after 3\u2009months (HR\u2009=\u20091.33; <jats:italic>P<\/jats:italic>\u2009=\u20090.003). However, no significant difference was observed for primary rTSR (fracture) (HR\u2009=\u20091.10; <jats:italic>P<\/jats:italic>\u2009=\u20090.484). Restricting rTSR (OA\/CA) to the best performing prosthesis combinations eliminated the difference between private and public outcomes (HR 1.10; <jats:italic>P<\/jats:italic>\u2009=\u20090.415). No other secondary analysis altered the primary result.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Differences exist between private and public hospitals for revision rate following primary shoulder replacement. Prosthesis selection accounts for some of the variation. Further analysis into patient specific characteristics is necessary to better understand these disparities.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.18604","type":"journal-article","created":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T05:05:47Z","timestamp":1693803947000},"page":"2097-2105","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Does hospital setting influence shoulder replacement revision rate? A national comparison of outcomes between private and public settings"],"prefix":"10.1111","volume":"93","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1771-5657","authenticated-orcid":false,"given":"Nicholas G.","family":"Paltoglou","sequence":"first","affiliation":[{"name":"Barwon Centre for Orthopaedic Research and Education St John of God Hospital, Barwon Health  Geelong Victoria Australia"},{"name":"School of Medicine Deakin University  Geelong Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8722-0572","authenticated-orcid":false,"given":"Stephen D.","family":"Gill","sequence":"additional","affiliation":[{"name":"Barwon Centre for Orthopaedic Research and Education St John of God Hospital, Barwon Health  Geelong Victoria Australia"},{"name":"School of Medicine Deakin University  Geelong Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Lorimer","sequence":"additional","affiliation":[{"name":"South Australian Health and Medical Research Institute (SAHMRI)  Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophia","family":"Corfield","sequence":"additional","affiliation":[{"name":"Australian Orthopaedic Association National Joint Replacement Registry  Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard S.","family":"Page","sequence":"additional","affiliation":[{"name":"Barwon Centre for Orthopaedic Research and Education St John of God Hospital, Barwon Health  Geelong Victoria Australia"},{"name":"School of Medicine Deakin University  Geelong Victoria Australia"},{"name":"Australian Orthopaedic Association National Joint Replacement Registry  Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,9,3]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Australian Orthopaedic Association National Joint Replacement Registry.AOANJRR Hip Knee & Shoulder Arthroplasty: 2020 Annual Report Adelaide; AOA 2020:1\u2013474. [Cited Aug 2021.] Available from URLhttps:\/\/aoanjrr.sahmri.com\/annual-reports-2020."},{"key":"e_1_2_9_3_1","unstructured":"New Zealand Joint Registry.The New Zealand Joint Registry: Sixteen Year Report January 1999 to December 2014. New Zealand Joint Registry.2015[updated Oct 2015 Cited Feb 2020.] Available from URLhttp:\/\/www.nzoa.org.nz\/system\/files."},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2012.03.004"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.3109\/17453674.2012.665327"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2018.03.017"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2014.04.001"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.J.01994"},{"key":"e_1_2_9_9_1","unstructured":"Australian Prudential Regulation Authority.Private Health Insurance Membership Trends. Statistics. Australian Prudential Regulation Authority Canberra;2020."},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.2165\/00148365-200504040-00005"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1071\/AH15228"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2022.07.007"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.15154"},{"key":"e_1_2_9_14_1","unstructured":"Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR).Hip Knee & Shoulder Arthroplasty Annual Report 2022. Adelaide AOA 1\u2010488;2022. Available from URL:https:\/\/aoanjrr.sahmri.com\/annual-reports-2022."},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00590-022-03436-3"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2019.10.026"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.190287"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-662-59568-8_2"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jseint.2021.01.001"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20200827-02"},{"key":"e_1_2_9_21_1","unstructured":"CrossT.Options for reforms and improvements to the prostheses list;2021."},{"key":"e_1_2_9_22_1","unstructured":"GillespieM.Consultation paper: options for reforms and improvements to the prostheses list; Australian Orthopaedic Association.2021."},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2020.05.008"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.19.01012"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2019.07.043"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-2197.2012.06113.x"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.98B3.35997"}],"container-title":["ANZ Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.18604","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T05:08:56Z","timestamp":1694754536000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ans.18604"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9]]},"references-count":26,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1111\/ans.18604"],"URL":"https:\/\/doi.org\/10.1111\/ans.18604","archive":["Portico"],"relation":{},"ISSN":["1445-1433","1445-2197"],"issn-type":[{"type":"print","value":"1445-1433"},{"type":"electronic","value":"1445-2197"}],"subject":[],"published":{"date-parts":[[2023,9]]},"assertion":[{"value":"2022-11-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-04","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-09-03","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}