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Predicting Hospital Readmissions After Total Shoulder Arthroplasty Within a Bundled Payment Cohort. J Am Acad Orthop Surg 2023; 31:199-204. [PMID: 36413375 DOI: 10.5435/jaaos-d-22-00449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Given the rising demand for shoulder arthroplasty, understanding risk factors associated with unplanned hospital readmission is imperative. No study to date has examined the influence of patient and hospital-specific factors as a predictive model for 90-day readmissions within a bundled payment cohort after primary shoulder arthroplasty. The purpose of this study was to determine predictive factors for 90-day readmissions after primary shoulder arthroplasty within a bundled payment cohort. METHODS After obtaining IRB approval, a retrospective review of a consecutive series of Medicare patients undergoing primary shoulder arthroplasty from 2014 to 2020 at a single academic institution was conducted. Patient demographic data, surgical variables, medical comorbidity profiles, medical risk scores, and social risk scores were collected. Postoperative variables included length of hospital stay, discharge location, and 90-day readmissions. Multivariate analysis was conducted to determine the independent risk factors of 90-day readmission. RESULTS Overall, 3.6% of primary shoulder arthroplasty patients (127/3,523) were readmitted within 90 days. Readmitted patients had a longer hospital course (1.75 versus 1.45 P = 0.006), higher comorbidity profile (4.64 versus 4.24 P = 0.001), higher social risk score (7.96 versus 6.9 P = 0.008), and higher medical risk score (10.1 versus 6.96 P < 0.001) and were more likely to require a home health aide or be discharged to an inpatient rehab facility or skilled nursing facility ( P = 0.002). Following multivariate analysis, an elevated medical risk score was associated with an increased risk of readmission (odds ratio = 1.05, P < 0.001). DISCUSSION This study demonstrates medical risk scores to be an independent risk factor of increased risk of 90-day hospital readmissions after primary shoulder arthroplasty within a bundled payment patient population. Additional incorporation of medical risk scores may be a beneficial adjunct in preoperative prediction for readmission and the potentially higher episode-of-care costs. LEVEL OF EVIDENCE Level III, retrospective cohort.
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Nassis E, Imas AS, Roth ES, Swiggett SJ, Ashraf AM, Diamond KB, Razi AE, Choueka J. A matched-control analysis on the effects of alcohol use disorder following primary reverse shoulder arthroplasty. J Orthop 2021; 24:186-189. [PMID: 33737792 DOI: 10.1016/j.jor.2021.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022] Open
Abstract
Introduction The purpose of this study was to determine whether alcohol use disorder (AUD) patients undergoing reverse shoulder arthroplasty (RSA) have increased: 1) lengths of stay (LOS); 2) complications; and 3) costs. Methods The study identified 19,168 patients in the study (n = 3198) and control (n = 15,970) cohort. In-hospital LOS, 90-day complications, and costs were assessed. Results AUD patients had significantly longer LOS (3- vs. 2-days, p < 0.0001), higher9 0-day medical complications (49.59 vs. 14.81%; p < 0.0001), and 90-day costs of care ($18,763.25 vs. $16,035.49, p < 0.0001). Conclusions The study is useful as it can allow healthcare professionals to adequately counsel these patients.
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Affiliation(s)
- Electra Nassis
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
| | - Alexander S Imas
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
| | - Eric S Roth
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
| | - Samuel J Swiggett
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
| | - Asad M Ashraf
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
| | - Keith B Diamond
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
| | - Afshin E Razi
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
| | - Jack Choueka
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
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Predicting Postoperative Course After Total Shoulder Arthroplasty Using a Medical-Social Evaluation Model. J Am Acad Orthop Surg 2020; 28:808-813. [PMID: 31904678 DOI: 10.5435/jaaos-d-19-00216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The ability to predict successful outcomes is important for patient satisfaction and optimal results after shoulder arthroplasty. We hypothesize that a medical-social scoring tool will predict resource requirements in doing total shoulder arthroplasty (TSA). METHODS A retrospective analysis of 453 patients undergoing TSA was undertaken. Preoperatively, medical and social surveys were completed by each patient. Demographics, comorbidity scores, hospital course, postdischarge disposition, and readmissions were collected. RESULTS The average length of stay was 1.6 days (0 to 7). There was an association with utilization of home care or inpatient rehabilitation and both the medical (7.3 versus 3.9; P = 0.0002) and social (7.1 versus 3.4; P < 0.0001) components of the survey. There was a weak correlation between hospital length of stay and the social component of the survey (R = 0.29; P < 0.001), but not the medical component (R = 0.04; P = 0.38). No variable was predictive of readmission. Social score of eight was found to be predictive of postoperative requirement of home care or rehabilitation. CONCLUSION This study found that Medical and Social Survey Scores can stratify patients who are at risk of requiring more advanced postdischarge care and/or a longer hospital stay. With this, we can match patients to the most appropriate level of postoperative care.
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Bixby EC, Boddapati V, Anderson MJJ, Mueller JD, Jobin CM, Levine WN. Trends in total shoulder arthroplasty from 2005 to 2018: lower complications rates and shorter lengths of stay despite patients with more comorbidities. JSES Int 2020; 4:657-661. [PMID: 32939502 PMCID: PMC7479025 DOI: 10.1016/j.jseint.2020.04.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Total shoulder arthroplasty (TSA) is an increasingly common procedure. This study looked at trends in TSA using a nationwide registry, with a focus on patient demographics, comorbidities, and complications. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent TSA from 2005 to 2018. Cohorts were created based on year of surgery: 2005-2010 (N = 1116), 2011-2014 (N = 5920), and 2015-2018 (N = 16,717). Patient demographics, comorbidities, operative time, hospital length of stay, discharge location, and complications within 30 days of surgery were compared between cohorts using bivariate and multivariate analysis. Results Bivariate analysis revealed significantly more comorbidities among patients in the 2015-2018 cohort compared with the 2005-2010 cohort, specifically American Society of Anesthesiologist class III or IV (57.0% vs. 44.3%, P < .001), morbid obesity (10.8% vs. 7.8%, P < .001), diabetes (17.8% vs. 12.1%, P < .001), and chronic obstructive pulmonary disease (6.7% vs. 4.1%, P = .003). The use of regional anesthesia has decreased (5.6% in 2005-2010 vs. 2.8% in 2015-2018, P < .001), as has operative time (▵: −16 minutes, P < .001) and length of stay (▵: −0.6 days, P < .001). There were also significant decreased rates of perioperative blood transfusion (OR [odds ratio], 0.46), non-home discharge (OR, 0.79), urinary tract infection (OR, 0.47), and sepsis (OR, 0.17), (P < .001 for all comparisons) between the 2005-2010 and 2015-2018 cohorts. Conclusions Between 2005 and 2018, patients undergoing TSA had increasingly more comorbidities but experienced lower rates of short-term complications, in the context of shorter hospitalizations and more frequent discharge to home.
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Affiliation(s)
- Elise C Bixby
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Venkat Boddapati
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Matthew J J Anderson
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - John D Mueller
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Charles M Jobin
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - William N Levine
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
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Traven SA, McGurk KM, Reeves RA, Walton ZJ, Woolf SK, Slone HS. Modified frailty index predicts medical complications, length of stay, readmission, and mortality following total shoulder arthroplasty. J Shoulder Elbow Surg 2019; 28:1854-1860. [PMID: 31202629 DOI: 10.1016/j.jse.2019.03.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The purpose of this study was to evaluate the 5-factor modified frailty index (mFI-5) as a predictor of postoperative complications in patients undergoing total shoulder arthroplasty (TSA). METHODS We conducted a retrospective analysis of the National Surgical Quality Improvement Program database for patients undergoing TSA between the years 2005 and 2017. The mFI-5 score, which includes the presence of comorbid diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functional status, was calculated for each patient. Multivariate logistic regression models were used to assess the relationship between the mFI-5 and postoperative complications. RESULTS A total of 18,957 patients undergoing TSA were identified. The mFI-5 was a strong predictor of serious medical complications (cardiac arrest, myocardial infarction, septic shock, pulmonary embolism, postoperative dialysis, reintubation, and prolonged ventilator requirement), discharge to a facility, and readmission (odds ratio ≥ 1.309, P ≤ .001). Length of stay also increased as the mFI-5 score increased (P < .001). However, among all the measured complications, the mFI-5 was the strongest predictor of mortality, with the risk more than doubling for each point increase in the mFI-5 score (odds ratio, 2.113; 95% confidence interval, 1.447-3.086; P < .001). CONCLUSION The mFI-5 predicts serious medical complications, increased length of stay, discharge to a facility, hospital readmission, and mortality in patients undergoing TSA. All of the variables within the mFI-5 are easily obtained through the patient history, allowing for a practical clinical tool that hospitals and surgeons can use to identify high-risk surgical candidates, inform preoperative counseling, and guide perioperative care to optimize patient outcomes.
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Affiliation(s)
- Sophia A Traven
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA.
| | - Kathy M McGurk
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| | - Russell A Reeves
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| | - Zeke J Walton
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| | - Shane K Woolf
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| | - Harris S Slone
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
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Abstract
Introduction Preoperative comorbidity seems to be an important factor for the functional recovery of patients after shoulder replacement, but few studies support this correlation.The purpose of this study was to clinically evaluate the influence of comorbidity in restoring function after shoulder replacement. Methods We performed a retrospective analysis of shoulder replacement accomplished at our institution from 2005 to 2016 (n = 70). Demographic data, number of comorbidities, preoperative drugs, type of arthroplasty, and postoperative complications were collected. Functional results were evaluated according to the QuickDASH questionnaire. Results QuickDASH as continuous data was directly correlated with number of drugs prior to the surgical intervention (R = 0.270, p = 0.024) and number of comorbidities (R = 0.280, p = 0,016); especially neurological disorders (R = 0.338, p = 0.004) and osteoporosis (R = 0.0242, p = 0.043). The QuickDASH score is inversely correlated with patient satisfaction (R = -0.621, p < 0.01) and with gender (male) (R = -0.469, p < 0.001).When the patients were divided into 2 equally sized groups according to the QuickDASH score, statistical significance was found between the group with the worst outcome and female sex (91.2%) (p < 0.001), neurological disorders (p = 0.004), alcohol consumption (p = 0.028) and when shoulder arthroplasty is due to proximal humeral fracture (p = 0.002). Conclusion Better functional results are obtained in patients with less comorbidities.Worse functional results are obtained in patients taking more drugs, in women, alcohol consumers and those after proximal humeral fractures. Preoperative clinical status must be optimized and the patients' comorbidities should be carefully taken into accounting order to ascertain the correct shoulder arthroplasty.
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Trends in the presentation, surgical treatment, and outcomes of tethered cord syndrome: A nationwide study from 2001 to 2010. J Clin Neurosci 2017; 41:92-97. [PMID: 28342704 DOI: 10.1016/j.jocn.2017.03.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/06/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This is a nationwide query into surgical management techniques for tethered cord syndrome, focusing on patient demographic, hospital characteristics, and treatment outcomes. Our hypothesis is that detethering vs. fusion for TCS results in different in-hospital complications. MATERIALS AND METHODS Retrospective review of the Nationwide Inpatient Sample 2001-2010. Inclusion: TCS discharges undergoing detethering or fusion. Sub-analysis compared TCS cases by age (pediatric [≤9years] vs. adolescent [10-18year]). Independent t-tests identified differences between fusion and detethering for hospital-related and surgical factors; multivariate analysis investigated procedure as a risk factor for complications/mortality. RESULTS 6457 TCS discharges: 5844 detetherings, 613 fusions. Fusion TCS had higher baseline Deyo Index (0.16 vs. 0.06), procedure-related complications (21.3% vs. 7.63%), and mortality (0.33% vs. 0.09%) than detethering, all p<0.001. Detethering for TCS was a significant factor for reducing mortality (OR 0.195, p<0.001), cardiac (OR 0.27, p<0.001), respiratory (OR 0.26, p<0.001), digestive system (OR 0.32, p<0.001), puncture nerve/vessel (OR 0.56, p=0.009), wound (OR 0.25, p<0.001), infection (OR 0.29, p<0.001), posthemorrhagic anemia (OR 0.04, p=0.002), ARDS (OR 0.13, p<0.001), and venous thrombotic (OR 0.53, p=0.043) complications. Detethering increased nervous system (OR 1.34, p=0.049) and urinary (OR 2.60, p<0.001) complications. Adolescent TCS had higher Deyo score (0.08 vs. 0.03, p<0.001), LOS (5.77 vs. 4.13days, p<0.001), and charges ($54,592.28 vs. $33,043.83, p<0.001), but similar mortality. Adolescent TCS discharges had increased prevalence of all procedure-related complications, and higher overall complication rate (11.10% vs. 5.08%, p<0.001) than pediatric. CONCLUSIONS With fusion identified as a significant risk factor for mortality and multiple procedure-related complications in TCS surgical patients, this study could aid surgeons in counseling TCS patients to optimize outcomes.
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Matsen FA, Li N, Gao H, Yuan S, Russ SM, Sampson PD. Factors Affecting Length of Stay, Readmission, and Revision After Shoulder Arthroplasty: A Population-Based Study. J Bone Joint Surg Am 2015; 97:1255-63. [PMID: 26246260 DOI: 10.2106/jbjs.n.01107] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Increased length of hospital stay, hospital readmission, and revision surgery are adverse outcomes that increase the cost of elective orthopaedic procedures, such as shoulder arthroplasty. Awareness of the factors related to these adverse outcomes will help surgeons and medical centers design strategies for minimizing their occurrence and for managing their associated costs. METHODS We analyzed data from the New York Statewide Planning and Research Cooperative System on 17,311 primary shoulder arthroplasties performed from 1998 to 2011 to identify factors associated with extended lengths of hospitalization after surgery, readmission within ninety days, and surgical revision. RESULTS The factors associated with each of these three adverse outcomes were different. Longer lengths of hospital stay were associated with female sex, advanced patient age, Medicaid insurance, comorbidities, fracture as the diagnosis for arthroplasty, higher hospital case volumes, and lower surgeon case volumes. Readmission was associated with advanced patient age and medical comorbidities. The most common diagnoses for readmission within ninety days were fluid and electrolyte imbalance (28%), acute pulmonary problems (21%), cardiac arrhythmia (20%), heart failure (15%), acute myocardial infarction (10%), and urinary tract infection (10%). Revision was associated with younger patient age and osteoarthritis or traumatic arthritis. The most common diagnoses at the time of revision surgery were unspecified mechanical complications of the implant (60%), shoulder pain (18%), dislocation of the prosthetic joint (12%), component loosening (10%), a broken prosthesis (8%), a cuff tear (7%), and infection (7%). CONCLUSIONS A small number of easily identified characteristics (sex, age, race, insurance type, comorbidities, diagnosis, and provider case volumes) were significantly associated with longer lengths of stay, readmission, and revision surgery. Consideration of these factors and their effects may guide efforts to improve patient safety and to manage the costs associated with these adverse outcomes.
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Affiliation(s)
- Frederick A Matsen
- Shoulder and Elbow Surgery Service, University of Washington Medical Center, Box 356500, Seattle, WA 98195-6500. E-mail address for F.A. Matsen:
| | - Ning Li
- Department of Statistics, University of Washington, Box 354322, Seattle, WA 98195-4322
| | - Huizhong Gao
- Department of Statistics, University of Washington, Box 354322, Seattle, WA 98195-4322
| | - Shaoqing Yuan
- Department of Statistics, University of Washington, Box 354322, Seattle, WA 98195-4322
| | - Stacy M Russ
- Shoulder and Elbow Surgery Service, University of Washington Medical Center, Box 356500, Seattle, WA 98195-6500. E-mail address for F.A. Matsen:
| | - Paul D Sampson
- Department of Statistics, University of Washington, Box 354322, Seattle, WA 98195-4322
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Dunn JC, Lanzi J, Kusnezov N, Bader J, Waterman BR, Belmont PJ. Predictors of length of stay after elective total shoulder arthroplasty in the United States. J Shoulder Elbow Surg 2015; 24:754-9. [PMID: 25591461 DOI: 10.1016/j.jse.2014.11.042] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/11/2014] [Accepted: 11/15/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) is an increasingly used treatment of glenohumeral arthritis and proximal humerus fractures. However, patient-specific characteristics affecting length of hospital stay postoperatively have not been elucidated. METHODS All patients undergoing primary unilateral TSA between 2005 and 2011 were isolated from the National Surgical Quality Improvement Program database. Patient demographics, medical comorbidities, and selected surgical variables were extracted, and length of stay was established as the primary end point of interest. Risk factors were expressed as odds ratios (ORs) with 95% confidence intervals by bivariate and multivariable analysis. RESULTS A total of 2004 patients were identified; the average age was 68.8 years, and 57% were women. Mean length of stay after TSA was 2.2 days (standard deviation, 1.7), and 91% of cases received hospital discharge in <3 days. Multivariable logistic regression analysis identified renal insufficiency (OR, 11.35; P = .0002), increased age (OR, 2.13; P = .011), longer operative time (OR, 1.94; P = .0041), and American Society of Anesthesiologists class ≥3 (OR, 1.86; P = .0016) as the most significant risk factors for length of stay. Gender also influenced length of stay; women were more likely to stay ≥4 days (OR, 0.44; P < .0001). CONCLUSIONS Perioperative risk stratification and preoperative counseling are paramount for patients undergoing TSA, particularly for those individuals with cardiac and renal disease or of advancing age. These variables may effectively predict prolonged hospital stay after TSA.
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Affiliation(s)
- John C Dunn
- Department of Orthopedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, TX, USA.
| | - Joseph Lanzi
- Department of Orthopedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Nicholas Kusnezov
- Department of Orthopedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Julia Bader
- Department of Orthopedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Brian R Waterman
- Department of Orthopedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Philip J Belmont
- Department of Orthopedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, TX, USA
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Waterman BR, Dunn JC, Bader J, Urrea L, Schoenfeld AJ, Belmont PJ. Thirty-day morbidity and mortality after elective total shoulder arthroplasty: patient-based and surgical risk factors. J Shoulder Elbow Surg 2015; 24:24-30. [PMID: 25168345 DOI: 10.1016/j.jse.2014.05.016] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 05/06/2014] [Accepted: 05/15/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) is an effective treatment for painful glenohumeral arthritis, but its morbidity has not been thoroughly documented. METHODS The National Surgical Quality Improvement Program database was queried to identify all patients undergoing primary TSA between 2006 and 2011, with extraction of selected patient-based or surgical variables and 30-day clinical course. Postoperative complications were stratified as major systemic, minor systemic, major local, and minor local, and mortality was recorded. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were derived from bivariate and multivariable analysis to express the association between risk factors and clinical outcomes. RESULTS Among the 2004 patients identified, the average age was 69 years, and 57% were women. Obesity was present in 46%, and 48% had an American Society of Anesthesiologists classification of ≥3. The 30-day mortality and total complication rates were 0.25% and 3.64%, respectively. Comorbid cardiac disease (OR, 85.31; 95% CI, 8.15, 892.84) and increasing chronologic age (OR, 1.19; 95% CI, 1.06, 1.33) were independent predictors of mortality, whereas peripheral vascular disease was associated with statistically significant increase in any complication (OR, 6.25; 95% CI, 1.24, 31.40). Operative time >174 minutes was an independent predictor for development of a major local complication (OR, 4.05; 95% CI, 1.45, 11.30). Obesity was not associated with any specified complication after controlling for other variables. CONCLUSIONS Whereas TSA has low short-term rates of perioperative complications and mortality, careful perioperative medical optimization and efficient surgical technique should be emphasized to decrease morbidity and mortality.
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Affiliation(s)
- Brian R Waterman
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA.
| | - John C Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Julia Bader
- Statistical Consulting Laboratory, University of Texas at El Paso, El Paso, TX, USA
| | - Luis Urrea
- El Paso Orthopaedic Surgery Group, Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Philip J Belmont
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA
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Griffin JW, Hadeed MM, Novicoff WM, Browne JA, Brockmeier SF. Patient age is a factor in early outcomes after shoulder arthroplasty. J Shoulder Elbow Surg 2014; 23:1867-1871. [PMID: 24957847 DOI: 10.1016/j.jse.2014.04.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 04/04/2014] [Accepted: 04/08/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Elderly and young patients alike are undergoing shoulder replacement at increased rates. In an era of outcomes reporting, risk adjustment, and cost containment, identifying patients likely to have adverse events is increasingly important. Our objective was to determine whether patient age is independently associated with postoperative in-hospital complications or increased hospital charges after shoulder arthroplasty. METHODS We used the Nationwide Inpatient Sample to analyze 58,790 patients undergoing total shoulder arthroplasty or hemiarthroplasty between 2000 and 2008. Multivariate analysis with logistic regression modeling was used to compare groups. Our objective was to determine whether age had an independent impact on the likelihood of postoperative in-hospital complications, mortality rate, length of stay, or charges after shoulder arthroplasty. RESULTS Patients aged 80 years or older had an increased in-hospital mortality rate (0.5%) compared with patients aged 50 to 79 years (0.1%) and patients aged younger than 50 years (0.1%). Predictors of death included female gender, total shoulder arthroplasty versus hemiarthroplasty, and Deyo score. Increased age was associated with slightly increased hospital charges. Length of stay was longer in patients aged 80 years or older compared with younger patients. After shoulder arthroplasty, postoperative anemia occurred more often in patients aged 80 years or older. Other postoperative complications including pulmonary embolism, infection, and cardiac complications were similar among groups. CONCLUSION Older patients tend to have longer hospital stays, an increased incidence of postoperative anemia, and slightly higher charges after shoulder arthroplasty. Advanced age is not associated with an increased incidence of pulmonary embolism, infection, and cardiac complications. Further research is warranted to explain the relationship between age and early postoperative outcomes.
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Affiliation(s)
- Justin W Griffin
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Michael M Hadeed
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Wendy M Novicoff
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - James A Browne
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Stephen F Brockmeier
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA.
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The Elixhauser comorbidity method outperforms the Charlson index in predicting inpatient death after orthopaedic surgery. Clin Orthop Relat Res 2014; 472:2878-86. [PMID: 24867450 PMCID: PMC4117875 DOI: 10.1007/s11999-014-3686-7] [Citation(s) in RCA: 375] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 05/07/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Scores derived from comorbidities can help with risk adjustment of quality and safety data. The Charlson and Elixhauser comorbidity measures are well-known risk adjustment models, yet the optimal score for orthopaedic patients remains unclear. QUESTIONS/PURPOSES We determined whether there was a difference in the accuracy of the Charlson and Elixhauser comorbidity-based measures in predicting (1) in-hospital mortality after major orthopaedic surgery, (2) in-hospital adverse events, and (3) nonroutine discharge. METHODS Among an estimated 14,007,813 patients undergoing orthopaedic surgery identified in the National Hospital Discharge Survey (1990-2007), 0.80% died in the hospital. The association of each Charlson comorbidity measure and Elixhauser comorbidity measure with mortality was assessed in bivariate analysis. Two main multivariable logistic regression models were constructed, with in-hospital mortality as the dependent variable and one of the two comorbidity-based measures (and age, sex, and year of surgery) as independent variables. A base model that included only age, sex, and year of surgery also was evaluated. The discriminative ability of the models was quantified using the area under the receiver operating characteristic curve (AUC). The AUC quantifies the ability of our models to assign a high probability of mortality to patients who die. Values range from 0.50 to 1.0, with 0.50 indicating no ability to discriminate and 1.0 indicating perfect discrimination. RESULTS Elixhauser comorbidity adjustment provided a better prediction of in-hospital case mortality (AUC, 0.86; 95% CI, 0.86-0.86) compared with the Charlson model (AUC, 0.83; 95% CI, 0.83-0.84) and to the base model with no comorbidities (AUC, 0.81; 95% CI, 0.81-0.81). In terms of relative improvement in predictive performance, the Elixhauser measure performed 60% better than the Charlson score in predicting mortality. The Elixhauser model discriminated inpatient morbidity better than the Charlson measure, but the discriminative ability of the model was poor and the difference in the absolute improvement in predictive power between the two models (AUC, 0.01) is of dubious clinical importance. Both comorbidity models exhibited the same degree of discrimination for estimating nonroutine discharge (AUC, 0.81; 95% CI, 0.81-0.82 for both models). CONCLUSIONS Provider-specific outcomes, particularly inpatient mortality, may be evaluated differently depending on the comorbidity risk adjustment model selected. Future research assessing and comparing the performance of the Charlson and Elixhauser measures in predicting long-term outcomes would be of value. LEVEL OF EVIDENCE Level II, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.
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Pappou I, Virani NA, Clark R, Cottrell BJ, Frankle MA. Outcomes and Costs of Reverse Shoulder Arthroplasty in the Morbidly Obese: A Case Control Study. J Bone Joint Surg Am 2014; 96:1169-1176. [PMID: 25031371 DOI: 10.2106/jbjs.m.00735] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The rising number of morbidly obese patients has important consequences for the health-care system. We investigated the effect of morbid obesity on outcomes, complications, discharge disposition, and costs in patients undergoing reverse shoulder arthroplasty. METHODS Our joint registry was searched for all patients who had undergone primary reverse shoulder arthroplasty for a reason other than fracture from 2003 to 2010 and had a minimum of twenty-four months of follow-up. Twenty-one patients with a body mass index (BMI) of ≥40 kg/m2 were identified (follow-up, 45 ± 16 months; sex, seventeen female and four male; age, 69 ± 7 years) and were compared with sixty-three matched control patients with a BMI of <30 kg/m2 (follow-up, 48 ± 20 months; sex, fifty female and thirteen male; age, 71 ± 6 years) after an a priori sample size calculation. Outcome instrument data were obtained preoperatively and postoperatively. The Charlson-Deyo comorbidity index (CDI) score, total comorbidities, operative time, blood loss, duration of hospital stay, discharge disposition, costs, and complications were recorded. RESULTS Compared with nonobese patients, morbidly obese patients had similar improvements in functional outcomes (e.g., American Shoulder and Elbow Surgeons score, 32 to 69 compared with 40 to 78) and in shoulder motion (e.g., forward flexion, 61° to 140° compared with 74° to 153°); all improvements were significant (p < 0.05). Morbidly obese patients had a similar rate of scapular notching (odds ratio [OR] = 0.58, p = 0.63), more total comorbidities excluding obesity (six compared with four, p = 0.001), a higher CDI (2 compared with 1, p = 0.025), and a higher rate of obstructive sleep apnea (OR = 27.7, p = 0.0001). Their operative time was thirteen minutes longer (p = 0.014) and their blood loss was 40 mL greater (p = 0.008). Morbidly obese patients had a similar duration of stay (3.1 compared with 2.6 days, p = 0.823) and hospital readmission rate (OR = 16.3, p = 0.08) but a sixfold higher rate of discharge to rehabilitation facilities rather than to home (OR = 8, p < 0.0001). Hospital costs were higher by $2974 (p = 0.009). The rates of major complications (n = 4 compared with 8, p = 0.479) and of minor complications (n = 3 compared with 14, p = 0.440) were similar. No intraoperative complications or mechanical device failures were noted in either group. CONCLUSIONS Reverse shoulder arthroplasty appears to be as safe and effective in morbidly obese patients, although it has an increased cost and patients have a lower rate of discharge to home and greater care needs after discharge. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ioannis Pappou
- Shoulder and Elbow Division, Florida Orthopaedic Institute, 13020 North Telecom Parkway, Tampa, FL 33637. E-mail address for M.A. Frankle:
| | - Nazeem A Virani
- Clinical Research Department, Foundation for Orthopaedic Research and Education, 13020 North Telecom Parkway, Tampa, FL 33637
| | - Rachel Clark
- Clinical Research Department, Foundation for Orthopaedic Research and Education, 13020 North Telecom Parkway, Tampa, FL 33637
| | - Benjamin J Cottrell
- Clinical Research Department, Foundation for Orthopaedic Research and Education, 13020 North Telecom Parkway, Tampa, FL 33637
| | - Mark A Frankle
- Shoulder and Elbow Division, Florida Orthopaedic Institute, 13020 North Telecom Parkway, Tampa, FL 33637. E-mail address for M.A. Frankle:
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D'Apuzzo MR, Pao AW, Novicoff WM, Browne JA. Age as an independent risk factor for postoperative morbidity and mortality after total joint arthroplasty in patients 90 years of age or older. J Arthroplasty 2014; 29:477-80. [PMID: 24029720 DOI: 10.1016/j.arth.2013.07.045] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 07/28/2013] [Accepted: 07/29/2013] [Indexed: 02/01/2023] Open
Abstract
The population of patients over 90 years of age has experienced the fastest growth in recent years. The number of primary total joint arthroplasties (TJA) has also been increasing. Our objectives were to examine in-hospital morbidity, mortality and resource consumption following primary TJA in patients older than 89 years at the national level. Nationwide Inpatient Sample was used to identify 8,340,167 patients who underwent TJA between 1993 and 2008, 58,355 (0.7%) were 90 years of age or older. Older patients were at higher risk of developing cardiac (OR 2.5; 95% CI 2.4-2.6), neurological (OR 2.1; 95% CI 1.8-2.4), respiratory complications and higher risk of mortality (OR 11.5; 95% CI 10.93-12.1) after controlling for baseline comorbidities. Age is an independent risk factor for postoperative complications and mortality. Our data can be used to educate patients on the risks before undergoing primary TJA and aid physicians in assessing and adjusting perioperative risk.
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Affiliation(s)
- Michele R D'Apuzzo
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Andrew W Pao
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Wendy M Novicoff
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - James A Browne
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
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Gilmer BB, Comstock BA, Jette JL, Warme WJ, Jackins SE, Matsen FA. 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. [PMID: 22810409 DOI: 10.2106/jbjs.k.00486] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Knowledge of the factors affecting the prognosis for improvement in function and comfort with time after shoulder arthroplasty is important to clinical decision-making. This study sought to identify some of these factors in 176 consecutive patients undergoing the ream-and-run procedure. METHODS The time course for improvement in patient function and comfort was determined for the entire group as well as for subsets by sex, age, diagnosis, preoperative function, and surgery date. Patients having repeat surgery were analyzed in detail. RESULTS Shoulder comfort and function increased progressively after the ream-and-run procedure, reaching a steady state by approximately twenty months. The shoulders in 124 patients with at least two years of follow-up were improved by a minimal clinically important difference. The shoulders in sixteen patients with at least two years of follow-up were not improved by the minimal clinically important difference. Twenty-two patients had repeat procedures, but only seven had revision to a total shoulder arthroplasty. Fourteen patients did not have either a known revision arthroplasty or two years of follow-up. The best prognosis was for male patients over the age of sixty years, with primary osteoarthritis, no prior surgical procedures, a preoperative score on the simple shoulder test of ≥5 points, and surgery after 2004. Repeat surgical procedures were more common in patients who had a greater number of surgical procedures before the ream-and-run surgery. CONCLUSIONS This study is unique in that it characterizes the factors affecting the time course for improvement in shoulder comfort and function after a ream-and-run procedure. Improvement occurs after this procedure for at least 1.5 years. This procedure appears to be best suited for an older male patient with reasonable preoperative shoulder function without prior shoulder surgery. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for authors for a complete description of levels of evidence.
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Affiliation(s)
- Brian B Gilmer
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Box 356500, 1959 N.E. Pacific Street, Seattle, WA 98195, USA
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Le TK, Montejano LB, Cao Z, Zhao Y, Ang D. Health care costs in US patients with and without a diagnosis of osteoarthritis. J Pain Res 2012; 5:23-30. [PMID: 22328832 PMCID: PMC3273404 DOI: 10.2147/jpr.s27275] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Osteoarthritis is a chronic and costly condition affecting 14% of adults in the US, and has a significant impact on patient quality of life. This retrospective cohort study compared direct health care utilization and costs between patients with osteoarthritis and a matched control group without osteoarthritis. Methods MarketScan® databases were used to identify adult patients with an osteoarthritis claim (ICD-9-CM, 715.xx) in 2007, and the date of first diagnosis served as the index. Patients were excluded if they did not have 12 months of continuous health care benefit prior to and following the index date, were aged <18 years, or lacked a second diagnosis code for osteoarthritis between 15 and 365 days pre-index or post-index. Osteoarthritis patients were matched 1:1 to patients without osteoarthritis for age group, gender, geographic region, health plan type, and Medicare eligibility. Multivariate analyses were conducted to assess for differences in utilization and costs, controlling for differences between cohorts. Results The study sample included 258,237 patients with osteoarthritis and 258,237 matched controls without osteoarthritis. Most patients were women and over 55 years of age. Patients with osteoarthritis had significantly higher pre-index rates of comorbidity than controls. Mean total adjusted direct costs for osteoarthritis patients were more than double those for the control group at US$18,435 (95% confidence interval [CI]: US$18,318–US$18,560) versus US$7494 (95% CI: US$7425–US$7557). Osteoarthritis patients incurred significantly higher inpatient costs at US$6668 (95% CI: US$6587–US$6744) versus US$1756 (95% CI: US$1717–US$1794), outpatient costs at US$7840 (95% CI: US$7786–US$7902) versus US$3675 (95% CI: US$3637–US$3711), and prescription drug costs at US$3213 (95% CI: US$3195–US$3233) versus US$2245 (95% CI: US$2229–US$2262) compared with the controls. Conclusion The direct health care costs of osteoarthritis patients were over two times higher than those of similar patients without the condition. The primary drivers of the cost difference were comorbidities and inpatient costs.
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Affiliation(s)
- T Kim Le
- Eli Lilly and Company, Indianapolis, IN
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Singh JA, Sperling JW, Cofield RH. Ninety day mortality and its predictors after primary shoulder arthroplasty: an analysis of 4,019 patients from 1976-2008. BMC Musculoskelet Disord 2011; 12:231. [PMID: 21992475 PMCID: PMC3206490 DOI: 10.1186/1471-2474-12-231] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 10/12/2011] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Examine 90-day postoperative mortality and its predictors following shoulder arthroplasty METHODS We identified vital status of all adults who underwent primary shoulder arthroplasty (Total shoulder arthroplasty (TSA) or humeral head replacement (HHR)) at the Mayo Clinic from 1976-2008, using the prospectively collected information from Total Joint Registry. We used univariate logistic regression models to assess the association of gender, age, body mass index, American Society of Anesthesiologist (ASA) class, Deyo-Charlson comorbidity index, an underlying diagnosis and implant fixation with odds of 90-day mortality after TSA or HHR. Multivariable models additionally adjusted for the type of surgery (TSA versus HHR). Adjusted Odds ratio (OR) with 95% confidence interval (CI) were calculated. RESULTS Twenty-eight of the 3, 480 patient operated died within 90-days of shoulder arthroplasty (0.8%). In multivariable-adjusted analyses, the following factors were associated with significantly higher odds of 90-day mortality: higher Deyo-Charlson index (OR, 1.54; 95% CI:1.39, 1.70; p < 0.001); a diagnosis of tumor (OR, 16.2; 95%CI:7.1, 36.7); and ASA class III (OR, 3.57; 95% CI:1.29, 9.91; p = 0.01) or class IV (OR, 13.4; 95% CI:2.44, 73.86; p = 0.003). BMI ≥ 30 was associated with lower risk of 90-day mortality (OR, 0.25; 95% CI:0.08, 0.78). In univariate analyses, patients undergoing TSA had significantly lower 90-day mortality of 0.4% (8/2, 580) compared to 1% in HHR (20/1, 411) (odds ratio, 0.22 (95% CI: 0.10, 0.50); p = 0.0003). CONCLUSIONS 90-day mortality following shoulder arthroplasty was low. An underlying diagnosis of tumor, higher comorbidity and higher ASA class were risk factors for higher 90-day mortality, while higher BMI was protective. Pre-operative comorbidity management may impact 90-day mortality following shoulder arthroplasty. A higher unadjusted mortality in patients undergoing TSA versus HHR may indicate the underlying differences in patients undergoing these procedures.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service and Center for Surgical Medical Acute care Research and Transitions-C-SMART, Birmingham VA Medical Center, Birmingham, AL, USA.
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Ricchetti ET, Abboud JA, Kuntz AF, Ramsey ML, Glaser DL, Williams GR. Total shoulder arthroplasty in older patients: increased perioperative morbidity? Clin Orthop Relat Res 2011; 469:1042-9. [PMID: 20878284 PMCID: PMC3048261 DOI: 10.1007/s11999-010-1582-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND More elderly patients are becoming candidates for total shoulder arthroplasty with an increase in frequency of the procedure paralleling the rise in other total joint arthroplasties. Controversy still exists, however, regarding the perioperative morbidity of total joint arthroplasty in elderly patients, particularly those 80 years of age and older. QUESTIONS/PURPOSES We asked whether perioperative complications and mortality, transfusion requirements, inpatient length of stay, and discharge disposition after total shoulder arthroplasty were similar in patients 80 years and older compared with those in younger patients. METHODS We retrospectively compared the 90-day complications, mortality, and other perioperative variables after total shoulder arthroplasty in 40 patients (43 shoulders) aged 80 years and older (Group A; mean age, 82 years) with 46 patients (47 shoulders) younger than 70 years (Group B; mean age, 61 years). RESULTS We found no differences in complication rates between Group A and B, including systemic (26% versus 11%) and local (5% versus 9%) complications or major (7% versus 2%) and minor (23% versus 17%) complications. There were no deaths in either group. Group A had an increased transfusion requirement (16% versus 2%) and a decreased number of direct to home discharges (67% versus 98%). Presence of systemic complications predicted increased length of stay in patients overall and in Group A patients. CONCLUSIONS Total shoulder arthroplasty can be performed in patients 80 years and older with rates of perioperative complications and mortalities comparable to those of younger patients, although these older patients may require a longer period of institutional care before return to home and may be more likely to require a blood transfusion. LEVEL OF EVIDENCE Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Eric T. Ricchetti
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107 USA
| | - Joseph A. Abboud
- 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, PA USA
| | - Andrew F. Kuntz
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA USA
| | - Matthew L. Ramsey
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107 USA
| | - David L. Glaser
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA USA
| | - Gerald R. Williams
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107 USA
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Cost effectiveness analysis of hemiarthroplasty and total shoulder arthroplasty. J Shoulder Elbow Surg 2010; 19:325-34. [PMID: 20303459 DOI: 10.1016/j.jse.2009.11.057] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 11/18/2009] [Accepted: 11/22/2009] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) are two viable surgical treatment options for glenohumeral osteoarthritis. Recent systematic reviews and randomized trials suggest that TSA, while more costly initially, may have superior outcomes with regard to pain, function and quality of life with lower revision rates. This study compared the cost-effectiveness of TSA with HA. METHODS A Markov decision model was constructed for a cost-utility analysis of TSA compared to HA in a cohort of 64-year-old patients. Outcome probabilities and effectiveness were derived from the literature. Costs were estimated from the societal perspective using the national average Medicare reimbursement for the procedures in 2008 US dollars. Effectiveness was expressed in quality-adjusted life years (QALYs) gained. Principal outcome measures were average incremental costs, incremental effectiveness, incremental QALYs, and net health benefits. RESULTS In the base case, HA resulted in a lower number of average QALYs gained at a higher average cost to society and was, therefore, dominated by the TSA strategy for the treatment of glenohumeral osteoarthritis. The cost effectiveness ratio for TSA and HA were $957/QALY and $1,194/QALY respectively. Sensitivity analysis revealed that if the utility of TSA is equal to, or revision rate lower than HA, TSA continues to be a dominant strategy. CONCLUSION Total shoulder arthroplasty with a cemented glenoid is a cost-effective procedure, resulting in greater utility for the patient at a lower overall cost to the payer. These findings suggest that TSA is the preferred treatment for certain populations from both a patient and payer perspective.
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The American Society of Shoulder and Elbow Therapists' consensus rehabilitation guideline for arthroscopic anterior capsulolabral repair of the shoulder. J Orthop Sports Phys Ther 2010; 40:155-68. [PMID: 20195022 DOI: 10.2519/jospt.2010.3186] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This manuscript describes the consensus rehabilitation guideline developed by the American Society of Shoulder and Elbow Therapists. The purpose of this guideline is to facilitate clinical decision making during the rehabilitation of patients following arthroscopic anterior capsulolabral repair of the shoulder. This guideline is centered on the principle of the gradual application of stress to the healing capsulolabral repair through appropriate integration of range of motion, strengthening, and shoulder girdle stabilization exercises during rehabilitation and daily activities. Components of this guideline include a 0- to 4-week period of absolute immobilization, a staged recovery of full range of motion over a 3-month period, a strengthening progression beginning at postoperative week 6, and a functional progression for return to athletic or demanding work activities between postoperative months 4 and 6. This document represents the first consensus rehabilitation guideline developed by a multidisciplinary society of international rehabilitation professionals specifically for the postoperative care of patients following arthroscopic anterior capsulolabral repair of the shoulder.
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