Predictors of Higher Costs Following Reverse Total Shoulder Arthroplasty

Objectives: The rising popularity of reverse total shoulder arthroplasties (RTSA) demands attention to its growing costs on the healthcare system, especially with the implementation of bundled payments. Charges associated with patients’ inpatient stays can be mitigated with a better understanding of the drivers of cost following RTSA. In this study, we evaluate potential pre -operative and post-operative factors associated with higher inpatient costs following RTSA.Methods: We identified ۵۹,۹۲۵ patients who underwent RTSA using the National Inpatient Sample between ۲۰۱۶ and ۲۰۱۹. Total inpatient hospital charges were collected, and patients were divided into “normal cost” or “high cost”groups. The high cost group was defined as patients with total costs greater than the ۷۵th percentile. Univariate and multivariate analyses were performed on pre-operative demographic and comorbidity variables as well as postoperative surgical and medical complications to predict factors associated with higher costs. T-tests and Chi-squared tests were performed, and odds ratios were calculated.Results: The mean total charges were ۱۴۱.۲۱۳.۹۳ in the high cost group and ۵۹,۱۸۱.۹۴ in the normal cost group. Following multivariate analysis, non-white patients were associated with higher costs by ۱.۳۱-fold (P<۰.۰۰۱), but sex and age were not. Cirrhosis and non-elective admission had higher odds of higher costs by ۱.۵۶-fold (P<۰.۰۰۱) and ۳.۱۳-fold (P<۰.۰۰۱), respectively. Among surgical complications, there were higher odds of high costs for periprosthetic infection by ۲.۴۳-fold (P<۰.۰۰۱), periprosthetic mechanical complication by ۱.۲۸-fold (P<۰.۰۰۱), and periprosthetic fracture by ۱.۵۶-fold (P<۰.۰۰۱). Medical complications generally had higher odds of high costs than surgical complications, with deep vein thrombosis having nearly five times (P<۰.۰۰۱) and myocardial infarction almost four times (P<۰.۰۰۱) higher odds of high inpatient costs.Conclusion: Post-operative medical complications were the most predictive factors of higher cost following RTSA. Pre-operative optimization to prevent infection and medical complications is imperative to mitigate the economic burden of RTSA’s. Level of evidence: III

کلیدواژه ها:

Complications ، Costs ، Predictor ، reverse total shoulder arthroplasty