Postoperative Clinical and Economic Outcomes of Patients With Reverse or Anatomic Total Shoulder Arthroplasty at One Year: A Retrospective, United States Hospital Billing Database Analysis

OBJECTIVES: Data on the one-year postoperative clinical and economic outcomes in a hospital setting after reverse (RTSA) and anatomic (ATSA) total shoulder arthroplasty (TSA) procedures are sparse.

METHODS: A retrospective cohort study using the Premier Healthcare Database, a hospital-billing database, evaluated one-year postoperative clinical and economic outcomes of RTSA and ATSA for patients with these procedures, years 2015-2021. All-cause hospital revisits including shoulder/non-shoulder complications and revision-related events, comprising irrigation/debridement and revision procedures/device removals, with and without infection were collected. The incidence and cost of these outcomes were evaluated. Generalized linear models were used to evaluate associations between patient characteristics and the outcome occurrences and costs.

RESULTS: In this study, 51,478 RTSA and 34,623 ATSA patients were identified (mean [standard deviation (SD)] ages RTSA 71.5 [8.1] years, ATSA 66.8 [9.0] years)). Nearly 45% RTSA and 42% ATSA patients had an all-cause hospital revisit. One-year adjusted incidences of irrigation/debridement, revision procedures/device removals, shoulder/non-shoulder complications after RTSA were 0.1% (95% Confidence Interval(CI): 0.1%-0.2%), 2.1% (95% CI: 2.0%-2.2%), 17.8% (95% CI: 17.5%-18.1%), and after ATSA were 0.2% (95% CI: 0.1%-0.2%), 1.9% (95% CI: 1.8%-2.1%), 14.4% (95% CI: 14.0%-14.8%), respectively; shoulder-related complications were 12.4% (95% CI: 12.1%-12.7%), RTSA; 9.9% (95% CI: 9.6%-10.3%), ATSA. Significant factors associated with high risk and cost of revision-related events and complications included chronic comorbidities and noncommercial insurance. Per patient, the mean (SD) total one-year hospital cost was $25,225 ($15,911), RTSA, and $21,520 ($13,531), ATSA. Revision procedure/device removals were the costliest postoperative visits per procedure (RTSA: $22,920 ($18,652); ATSA: $26,911 ($18,619)). Patients with revision-related events with infections had higher total hospital costs than patients without these events, $60,887 (95%CI: $56,951, $64,823), RTSA and $59,478 (95%CI: $52,312, $66,644), ATSA.

CONCLUSIONS: This study highlights the need for technologies and surgical techniques that may help reduce the postoperative healthcare utilization and economic burden associated with TSA.