Department of Orthopaedic Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
Department of Orthopaedic Surgery, Wayne State University School of Medicine, Taylor, MI, USA.
Musculoskelet Surg. 2020 Apr;104(1):37-42. doi: 10.1007/s12306-018-0584-2. Epub 2019 Jan 1.
The use of reverse shoulder arthroplasty (RSA) continues to grow with expanding indications and increased surgeon awareness. Previous data for other lower extremity joint replacements indicate that high-volume centers have better outcomes, with lower complication rates, decreased length of stay, and complications for both hemiarthroplasty and total shoulder arthroplasty. The purpose of this study is to evaluate the effects of hospital size and setting on adverse events for RSA.
The National Inpatient Sample database was queried for RSA performed using ICD-9 codes. Primary outcomes included length of stay (LOS), total hospital charges, discharge disposition, and postoperative complications. Odds ratios were used to assess the risk of inpatient postoperative complications.
A weighted national estimate of 24,056 discharges for patients undergoing RSA was included in the study. Patients at larger hospitals experienced higher total charges, increased average LOS, and slightly higher complication rates compared to those of small and medium hospitals. Patients in larger hospitals had significantly increased rates of genitourinary and central nervous system complications, while patients in small/medium hospitals experienced higher rates of hematoma/seroma.
Results from this study indicate that large and non-teaching hospitals overall tend to burden the patients with higher hospital charges, longer hospital stay, and more frequent non-routine discharges. Also, larger hospitals are associated with higher risk of genitourinary and central nervous system complications rates, whereas non-teaching hospitals are associated with lower risk of infection and higher risk of anemia after RSA. With the growth in RSA in the USA, continued attention needs to be placed on improving outcomes and resource utilization for RSA patients even in larger hospitals.
随着适应证的扩大和外科医生认识的提高，反向肩关节置换术（RSA）的应用不断增加。其他下肢关节置换术的先前数据表明，高容量中心的结果更好，并发症发生率更低，住院时间更短，半肩置换术和全肩关节置换术的并发症也更少。本研究的目的是评估医院规模和设置对 RSA 不良事件的影响。
使用 ICD-9 代码对国家住院患者样本数据库进行 RSA 检索。主要结果包括住院时间（LOS）、总住院费用、出院去向和术后并发症。使用比值比评估住院术后并发症的风险。
研究纳入了一项全国性的 RSA 患者加权估计值为 24056 例。与小中和大医院相比，大医院的患者经历了更高的总费用、平均 LOS 增加和稍高的并发症发生率。大医院的患者泌尿系统和中枢神经系统并发症发生率显著增加，而小/中型医院的患者血肿/血清肿发生率更高。
本研究结果表明，大型和非教学医院总体上倾向于使患者承受更高的住院费用、更长的住院时间和更频繁的非常规出院。此外，大医院与泌尿系统和中枢神经系统并发症发生率较高相关，而非教学医院与感染风险较低和 RSA 后贫血风险较高相关。随着 RSA 在美增长，需要继续关注改善 RSA 患者的结局和资源利用，即使是在大医院。
