Trends in Volume of Wrist Arthroscopy Among American Board of Orthopaedic Surgery Part II Candidates.

Abstract

Introduction: Advancements in technology have spurred research interest in wrist arthroscopy. This study serves to identify trends in wrist arthroscopy utilization among American Board of Orthopaedic Surgery (ABOS) Part II candidates, with a focus on fellowship training status and the volume of wrist arthroscopy in early practice.

Methods: A search of the ABOS Part II Examination Database was conducted, including all cases performed from 2009 to 2020. All cases involving wrist arthroscopy as identified by current procedural terminology code were eligible for inclusion. Trends in wrist arthroscopy utilization rates, surgical volume, fellowship training, and complications were collected and analyzed.

Results: Annual wrist arthroscopy case volume remained stable between 2009 and 2020 (P = 0.11), despite an increasing number of ABOS candidates each year (P = 0.005). Most candidates (n = 844, 90%) performed one or fewer wrist arthroscopy cases per month. Hand and upper extremity fellowship-trained surgeons performed 95.7% (n = 2653/2772) of cases. The case volume remained stable among hand fellowship-trained surgeons (P = 0.15); however, case volumes decreased among non-hand-trained surgeons (P = 0.016). Surgical complications occurred in 13.2% of cases and were higher among diagnostic arthroscopy cases (17.9%, P = 0.03).

Discussion: Over the past decade, wrist arthroscopy case volumes have remained stable, despite an increasing number of ABOS candidates. Although nearly all procedures were performed by surgeons with hand and upper extremity fellowship training, there was a decrease wrist arthroscopy rates among surgeons without hand and upper extremity fellowship training. Complication rates in this study were high and mirrored complication rates of inexperienced or low-volume surgeons as reported in existing literature.