Sage Journals: Discover world-class research

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.

Keywords

Revision shoulder arthroplasty reverse total shoulder anatomic total shoulder hemiarthroplasty cost analysis patient reported outcomes

Get full access to this article

View all access options for this article.

References

Wagner

Farley

Higgins

, et al. The incidence of shoulder arthroplasty: rise and future projections compared with hip and knee arthroplasty. J Shoulder Elbow Surg 2020; 29: 2601–2609.

Farley

Wilson

Kumar

, et al. Prevalence of shoulder arthroplasty in the United States and the increasing burden of revision shoulder arthroplasty. JB JS Open Access 2021; 6: e20.00156.

Lopez

Boddapati

Anderson

MJJ

, et al. Recent trends in Medicare utilization and surgeon reimbursement for shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30: 120–126.

Menendez

Lawler

Shaker

, et al. Time-driven activity-based costing to identify patients incurring high inpatient cost for total shoulder arthroplasty. J Bone Joint Surg Am 2018; 100: 2050–2056.

Gilmer

Comstock

Jette

, et al. The prognosis for improvement in comfort and function after the ream-and-run arthroplasty for glenohumeral arthritis: an analysis of 176 consecutive cases. J Bone Joint Surg Am 2012; 94: e102.

Harris

Taylor

Thielke

, et al. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377–381.

Carducci

Mahendraraj

Menendez

, et al. Identifying surgeon and institutional drivers of cost in total shoulder arthroplasty: a multicenter study. J Shoulder Elbow Surg 2021; 30: 113–119.

Chawla

Whitson

Schiffman

, et al. Drivers of lower inpatient hospital costs and greater improvements in health-related quality of life for patients undergoing total shoulder and ream-and-run arthroplasty. J Shoulder Elbow Surg 2021; 30: e503–e516.

Steen

Cabezas

Santoni

, et al. Outcome and value of reverse shoulder arthroplasty for treatment of glenohumeral osteoarthritis: a matched cohort. J Shoulder Elbow Surg 2015; 24: 1433–1441.

10.

Lapner

Kumar

van Katwyk

, et al. Total shoulder arthroplasty is cost-effective compared with hemiarthroplasty: a real-world economic evaluation. J Bone Joint Surg Am 2021; 103: 1499–1509.

11.

Mather

3rd Watters

Orlando

, et al. Cost effectiveness analysis of hemiarthroplasty and total shoulder arthroplasty. J Shoulder Elbow Surg 2010; 19: 325–334.

12.

Solomon

Joseph

Shishani

, et al. Cost analysis of hemiarthroplasty versus reverse shoulder arthroplasty for fractures. Orthopedics 2016; 39: 230–234.

13.

Polisetty

Colley

Levy

. Value analysis of anatomic and reverse shoulder arthroplasty for glenohumeral osteoarthritis with an intact rotator cuff. J Bone Joint Surg Am 2021; 103: 913–920.

14.

Kadum

Inngul

Ihrman

, et al. Higher preoperative sensitivity to pain and pain at rest are associated with worse functional outcome after stemless total shoulder arthroplasty: a prospective cohort study. Bone Joint J 2018; 100-B: 480–484.

15.

Polisetty

Malarkey

Colley

, et al. Reverse total shoulder arthroplasty for patients with minimal preoperative pain: a matched-cohort analysis. J Shoulder Elbow Surg 2021; 30: 609–615.

16.

Chalmers

Kahn

Broschinsky

, et al. An analysis of costs associated with shoulder arthroplasty. J Shoulder Elbow Surg 2019; 28: 1334–1340.

17.

Fang

Pagani

Gordon

, et al. Episode-of-care costs for revision total joint arthroplasties by decadal age groups. Geriatrics (Basel) 2021; 6: 49.

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