OBJECTIVES:

Total shoulder arthroplasty (TSA), while generally a successful procedure that improves shoulder function, can be associated with high post-operative resource utilization. Studies on hospital costs of post-operative care are sparse. The study objective was to estimate post-operative hospital costs after TSA and evaluate cost differences among patient characteristics.

METHODS:

A retrospective cohort study was performed using a U.S.-based hospital database, Premier Healthcare Database. Patients that had reverse (RTSA) or anatomic (ATSA) TSA were included. Major exclusions were upper arm/shoulder fracture/trauma, infection and cancer. RTSA and ATSA cohorts were analyzed separately. Hospital costs of one-year all-cause readmissions, revision procedures, and complication-related readmissions were collected, and inflation adjusted to year 2022. Generalized linear models were used to compare cost differences.

RESULTS: The total cohort sizes were 51,557 RTSA and 34,680 ATSA patients. The mean (standard deviation (SD)) ages were 71.5 (8.1) years, RTSA, 66.8 (9.0) years, ATSA. The mean (SD) hospital costs of the initial surgeries were $20,956 ($8,632), RTSA, and $18,188 ($8,155), ATSA. The one-year adjusted incidence of all-cause readmissions, revisions, and complications after RTSA were 45.0% (95% Confidence Interval (CI): 44.6%-45.5%), 2.3% (95% CI: 2.1%-2.4%), and 12.4% (95% CI: 12.1%-12.7%) and after ATSA were 42.3% (95% CI: 41.8%-42.9%), 2.1% (95% CI: 2.0%-2.3%), and 10.1% (95% CI: 9.8%-10.5%), respectively. Estimated mean (SD) costs for RTSA readmissions, revision and complications were $9,091($17,644), $19,337($14,022), and $13,106($22,060), respectively; and for ATSA were $8,061($14,934), $20,048($12,714), and $11,839($18,380), respectively. For both ATSA/RTSA, statistically significant cost differences included, but were not limited to, higher cost of readmissions/revision/complications for patients with noncommercial versus commercial insurance.

CONCLUSIONS:

Postoperatively, the most expensive revisits to the hospital after TSA were for revision procedures, which generated mean hospital costs of approximately $20,000 per patient. As the demand for TSA rises, there is a need for surgical approaches/techniques that promote faster recovery and minimize post-surgical complications.