Factors associated with higher inpatient hospitalization costs and improvements in shoulder-specific patient-reported outcomes following revision shoulder arthroplasty

Abstract

Background

There are no studies assessing predictors of inpatient costs and clinical improvement following revision shoulder arthroplasty. The objectives of this study were to determine (1) what patient and surgical characteristics drive inpatient hospitalization costs of revision shoulder arthroplasty, and (2), how do these factors influence patient-reported outcomes following revision shoulder arthroplasty?

Methods

Retrospective single-center study of single-stage revision arthroplasty for aseptic failure with a minimum two-year follow-up were included. Hospital inpatient cost data was obtained from an institutional billing database. Demographics, procedural characteristics, and pre and postoperative clinical outcome data were recorded. Univariable and multivariable analyses were used to identify predictors of hospitalization costs and patient-reported outcomes.

Results

110 patients with an average of 4.1 ± 1.6 years of clinical follow-up were included. The average cost of revision shoulder arthroplasty was $11,809 ± 3383. The cost per point of SST score improvement was $3,374, while minimum clinically important difference achievement was $14,509. Predictors of higher hospitalization costs were higher preoperative pain (p = 0.020), revision reverse shoulder arthroplasty (p = 0.007) and TSA (p = 0.10) versus HA, and previous revision surgery (p = 0.024).

Discussion

Direct costs of revision shoulder arthroplasty are primarily driven by implant-related costs, and the cost per improvement in patient-reported outcomes is high compared to primary arthroplasty.

Level of Evidence

Level III; Retrospective Cohort Comparison; Economic and Treatment Study.