Abstract：
BACKGROUND: Data on the 1-year postoperative revision, complication, and economic outcomes in a hospital setting after total shoulder arthroplasty (TSA) are sparse.
METHODS: A retrospective cohort study using the Premier Healthcare Database, a hospital-billing data source, evaluated 1-year postoperative revision, complication, and economic outcomes of reverse (RTSA) and anatomic (ATSA) TSA for patients who underwent the procedure from 2015 until 2021. All-cause revisits, including revision-related events (categorized as either irrigation and débridement or revision procedures and device removals) and shoulder/nonshoulder complications were collected. The incidences and costs of these revisits were evaluated. Generalized linear models were used to evaluate the associations between patient characteristics and revision and complication occurrences and costs.
RESULTS: Among 51,478 RTSA and 34,623 ATSA patients (mean [standard deviation] ages RTSA 71.5 [8.1] years, ATSA 66.8 [9.0] years), 1-year adjusted incidences of all-cause revisits, irrigation/débridement, revision procedures/device removals, and shoulder/nonshoulder complications were RTSA: 45.0% (95% confidence interval (CI): 44.6%-45.5%), 0.1% (95% CI: 0.1%-0.2%), 2.1% (95% CI: 2.0%-2.2%), and 17.8% (95% CI: 17.5%-18.1%) and ATSA: 42.3% (95% CI: 41.8%-42.9%), 0.2% (95% CI: 0.1%-0.2%), 1.9% (95% CI: 1.8%-2.1%), and 14.4% (95% CI: 14.0%-14.8%), respectively; shoulder-related complications were RTSA: 12.4% (95% CI: 12.1%-12.7%) and ATSA: 9.9% (95% CI: 9.6%-10.3%). Significant factors associated with a high risk of revisions and complications included, but were not limited to, chronic comorbidities and noncommercial insurance. Per patient, the mean (standard deviations) total 1-year hospital cost was $25,225 ($15,911) and $21,520 ($13,531) for RTSA and ATSA, respectively. Revision procedures and device removals were most costly, averaging $22,920 ($18,652) and $26,911 ($18,619) per procedure for RTSA and ATSA, respectively. Patients with revision-related events with infections had higher total hospital costs than patients without this event (RTSA: $60,887 (95% CI: $56,951-$64,823) and ATSA: $59,478 (95% CI: $52,312-$66,644)), equating to a mean difference of $36,148 with RTSA and $38,426 with ATSA. Significant factors associated with higher costs of revision-related events and complications included age, race, chronic comorbidities, and noncommercial insurance.
CONCLUSIONS: Nearly 45% RTSA and 42% ATSA patients returned to the hospital, most often for shoulder/nonshoulder complications (overall 17.8% RTSA and 14.4% ATSA, and shoulder-related 12.4% RTSA and 9.9% ATSA). Revisions and device removals were most expensive ($22,920 RTSA and $26,911 ATSA). Infection complications requiring revision had the highest 1-year hospital costs (∼$60,000). This study highlights the need for technologies and surgical techniques that may help reduce TSA health care utilization and economic burden.
METHODS: A retrospective cohort study using the Premier Healthcare Database, a hospital-billing data source, evaluated 1-year postoperative revision, complication, and economic outcomes of reverse (RTSA) and anatomic (ATSA) TSA for patients who underwent the procedure from 2015 until 2021. All-cause revisits, including revision-related events (categorized as either irrigation and débridement or revision procedures and device removals) and shoulder/nonshoulder complications were collected. The incidences and costs of these revisits were evaluated. Generalized linear models were used to evaluate the associations between patient characteristics and revision and complication occurrences and costs.
RESULTS: Among 51,478 RTSA and 34,623 ATSA patients (mean [standard deviation] ages RTSA 71.5 [8.1] years, ATSA 66.8 [9.0] years), 1-year adjusted incidences of all-cause revisits, irrigation/débridement, revision procedures/device removals, and shoulder/nonshoulder complications were RTSA: 45.0% (95% confidence interval (CI): 44.6%-45.5%), 0.1% (95% CI: 0.1%-0.2%), 2.1% (95% CI: 2.0%-2.2%), and 17.8% (95% CI: 17.5%-18.1%) and ATSA: 42.3% (95% CI: 41.8%-42.9%), 0.2% (95% CI: 0.1%-0.2%), 1.9% (95% CI: 1.8%-2.1%), and 14.4% (95% CI: 14.0%-14.8%), respectively; shoulder-related complications were RTSA: 12.4% (95% CI: 12.1%-12.7%) and ATSA: 9.9% (95% CI: 9.6%-10.3%). Significant factors associated with a high risk of revisions and complications included, but were not limited to, chronic comorbidities and noncommercial insurance. Per patient, the mean (standard deviations) total 1-year hospital cost was $25,225 ($15,911) and $21,520 ($13,531) for RTSA and ATSA, respectively. Revision procedures and device removals were most costly, averaging $22,920 ($18,652) and $26,911 ($18,619) per procedure for RTSA and ATSA, respectively. Patients with revision-related events with infections had higher total hospital costs than patients without this event (RTSA: $60,887 (95% CI: $56,951-$64,823) and ATSA: $59,478 (95% CI: $52,312-$66,644)), equating to a mean difference of $36,148 with RTSA and $38,426 with ATSA. Significant factors associated with higher costs of revision-related events and complications included age, race, chronic comorbidities, and noncommercial insurance.
CONCLUSIONS: Nearly 45% RTSA and 42% ATSA patients returned to the hospital, most often for shoulder/nonshoulder complications (overall 17.8% RTSA and 14.4% ATSA, and shoulder-related 12.4% RTSA and 9.9% ATSA). Revisions and device removals were most expensive ($22,920 RTSA and $26,911 ATSA). Infection complications requiring revision had the highest 1-year hospital costs (∼$60,000). This study highlights the need for technologies and surgical techniques that may help reduce TSA health care utilization and economic burden.
摘要：
背景：术后一年翻修的数据，并发症,全肩关节置换术（TSA）后医院的经济结果很少。
方法：使用PremierHealthcare数据库的回顾性队列研究，医院账单数据源，评估术后一年的翻修，并发症,以及2015年至2021年接受手术的患者的逆转（RTSA）和解剖（ATSA）TSA的经济结果。所有原因的重访，收集了与翻修相关的事件(分为冲洗和清创或翻修手术和器械移除)和肩部/非肩部并发症.评估了这些重新访问的发生率和成本。使用广义线性模型来评估患者特征与翻修，并发症发生率和成本之间的关联。
结果：在51,478名RTSA和34,623名ATSA患者（平均[标准偏差（SD）]年龄为71.5[8.1]岁，ATSA66.8[9.0]年），一年调整后的全因重访发生率，灌溉/清创，修订程序/设备移除,和肩关节/非肩关节并发症为RTSA:45.0%(95%可信区间(CI):44.6%-45.5%),0.1%（95%CI：0.1%-0.2%），2.1%（95%CI：2.0%-2.2%），和17.8%（95%CI：17.5%-18.1%）和ATSA：42.3%（95%CI：41.8%-42.9%），0.2%（95%CI：0.1%-0.2%），1.9%（95%CI：1.8%-2.1%），和14.4%（95%CI：14.0%-14.8%），肩关节相关并发症分别为RTSA:12.4%(95%CI:12.1%-12.7%)和ATSA:9.9%(95%CI:9.6%-10.3%)。与翻修和并发症高风险相关的重要因素包括，但不仅限于，慢性合并症和非商业保险。每位患者，RTSA和ATSA的平均(SD)一年总住院费用为25,225美元(15,911美元)和21,520美元(13,531美元)，分别。修订程序和设备移除成本最高，RTSA和ATSA的平均每个程序$22,920（$18,652）和$26,911（$18,619），分别。与感染相关的翻修事件患者的总住院费用高于没有此事件的患者（RTSA：$60,887（95％CI：$56,951-$64,823）和ATSA：$59,478（95％CI：$52,312-$66,644），与RTSA的平均差为36,148美元，与ATSA的平均差为38,426美元。与翻修相关事件和并发症的较高成本相关的重要因素包括年龄，种族,慢性合并症,非商业保险。
结论：近45％的RTSA和42％的ATSA患者返回医院，最常见的是肩关节/非肩关节并发症（总共17.8%的RTSA和14.4%的ATSA，和肩部相关的12.4%RTSA和9.9%ATSA)。修订和设备拆卸费用最高(22,920美元的RTSA和26,911美元的ATSA)。需要翻修的感染并发症的一年住院费用最高（约60,000美元）。这项研究强调了对可能有助于减少TSA医疗保健利用率和经济负担的技术和外科技术的需求。
方法：使用PremierHealthcare数据库的回顾性队列研究，医院账单数据源，评估术后一年的翻修，并发症,以及2015年至2021年接受手术的患者的逆转（RTSA）和解剖（ATSA）TSA的经济结果。所有原因的重访，收集了与翻修相关的事件(分为冲洗和清创或翻修手术和器械移除)和肩部/非肩部并发症.评估了这些重新访问的发生率和成本。使用广义线性模型来评估患者特征与翻修，并发症发生率和成本之间的关联。
结果：在51,478名RTSA和34,623名ATSA患者（平均[标准偏差（SD）]年龄为71.5[8.1]岁，ATSA66.8[9.0]年），一年调整后的全因重访发生率，灌溉/清创，修订程序/设备移除,和肩关节/非肩关节并发症为RTSA:45.0%(95%可信区间(CI):44.6%-45.5%),0.1%（95%CI：0.1%-0.2%），2.1%（95%CI：2.0%-2.2%），和17.8%（95%CI：17.5%-18.1%）和ATSA：42.3%（95%CI：41.8%-42.9%），0.2%（95%CI：0.1%-0.2%），1.9%（95%CI：1.8%-2.1%），和14.4%（95%CI：14.0%-14.8%），肩关节相关并发症分别为RTSA:12.4%(95%CI:12.1%-12.7%)和ATSA:9.9%(95%CI:9.6%-10.3%)。与翻修和并发症高风险相关的重要因素包括，但不仅限于，慢性合并症和非商业保险。每位患者，RTSA和ATSA的平均(SD)一年总住院费用为25,225美元(15,911美元)和21,520美元(13,531美元)，分别。修订程序和设备移除成本最高，RTSA和ATSA的平均每个程序$22,920（$18,652）和$26,911（$18,619），分别。与感染相关的翻修事件患者的总住院费用高于没有此事件的患者（RTSA：$60,887（95％CI：$56,951-$64,823）和ATSA：$59,478（95％CI：$52,312-$66,644），与RTSA的平均差为36,148美元，与ATSA的平均差为38,426美元。与翻修相关事件和并发症的较高成本相关的重要因素包括年龄，种族,慢性合并症,非商业保险。
结论：近45％的RTSA和42％的ATSA患者返回医院，最常见的是肩关节/非肩关节并发症（总共17.8%的RTSA和14.4%的ATSA，和肩部相关的12.4%RTSA和9.9%ATSA)。修订和设备拆卸费用最高(22,920美元的RTSA和26,911美元的ATSA)。需要翻修的感染并发症的一年住院费用最高（约60,000美元）。这项研究强调了对可能有助于减少TSA医疗保健利用率和经济负担的技术和外科技术的需求。
