Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA.
Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA.
J Shoulder Elbow Surg. 2023 Oct;32(10):2043-2050. doi: 10.1016/j.jse.2023.04.003. Epub 2023 May 22.
Parkinson disease (PD) is an established risk factor for higher rates of complications and revision surgery following shoulder arthroplasty, yet the economic burden of PD remains to be elucidated. The purpose of this study is to compare rates of complication and revisions as well as inpatient charges for shoulder arthroplasty procedures between PD and non-PD patients using an all-payer statewide database.
Patients undergoing primary shoulder arthroplasty from 2010 to 2020 were identified from the New York (NY) Statewide Planning and Research Cooperative System (SPARCS) database. Study groups were assigned based on concomitant diagnosis of PD at the time of index procedure. Baseline demographics, inpatient data, and medical comorbidities were collected. Primary outcomes measured were accommodation, ancillary, and total inpatient charges. Secondary outcomes included postoperative complication and reoperation rates. Logistic regression was performed to evaluate effect of PD on shoulder arthroplasty revision and complication rates. All statistical analysis was performed using R.
A total of 39,011 patients (429 PD vs. 38,582 non-PD) underwent 43,432 primary shoulder arthroplasties (477 PD vs. 42,955 non-PD) with mean follow-up duration of 2.9 ± 2.8 years. The PD cohort was older (72.3 ± 8.0 vs. 68.6 ± 10.4 years, P < .001), with greater male composition (50.8% vs. 43.0%, P = .001), and higher mean Elixhauser scores (1.0 ± 4.6 vs. 7.2 ± 4.3, P < .001). The PD cohort had significantly greater accommodation charges ($10,967 vs. $7,661, P < .001) and total inpatient charges ($62,000 vs. $56,000, P < .001). PD patients had significantly higher rates of revision surgery (7.7% vs. 4.2%, P = .002) and complications (14.1% vs. 10.5%, P = .040), as well as significantly higher incidences of readmission at 3 and 12 months postoperatively. After controlling for age and baseline comorbidities, PD patients had 1.64 times greater odds of reoperation compared to non-PD patients (95% CI 1.10, 2.37; P = .012) and a hazard ratio of 1.54 for reoperation when evaluating revision-free survival following primary shoulder arthroplasty (95% CI 1.07, 2.20; P = .019).
PD confers a longer length of stay, higher rates of postoperative complications and revisions, and greater inpatient charges in patients undergoing TSA. Knowledge of the associated risks and resource requirements of this population will aid surgeons in their decision making as they continue to provide care to a growing number of patients affected by PD.
帕金森病（PD）是肩关节炎置换术后并发症和翻修手术发生率较高的既定危险因素，但 PD 的经济负担仍有待阐明。本研究旨在通过全州支付者数据库比较 PD 和非 PD 患者的肩关节炎置换术并发症和翻修率以及住院费用。
从纽约州全州规划和研究合作系统（SPARCS）数据库中确定了 2010 年至 2020 年接受初次肩关节炎置换术的患者。根据指数手术时同时诊断为 PD 来分组。收集基线人口统计学、住院数据和合并症。主要结果是评估住院期间的住宿、辅助和总费用。次要结果包括术后并发症和再手术率。采用 logistic 回归评估 PD 对肩关节炎置换术翻修和并发症发生率的影响。所有统计分析均使用 R 进行。
共有 39011 例患者（429 例 PD 与 38582 例非 PD）接受了 43432 例初次肩关节炎置换术（477 例 PD 与 42955 例非 PD），平均随访时间为 2.9±2.8 年。PD 组年龄较大（72.3±8.0 岁与 68.6±10.4 岁，P<.001），男性比例更高（50.8%与 43.0%，P=.001），平均 Elixhauser 评分更高（1.0±4.6 分与 7.2±4.3 分，P<.001）。PD 组的住宿费用（$10967 与 $7661，P<.001）和总住院费用（$62000 与 $56000，P<.001）显著更高。PD 患者的翻修手术率（7.7%与 4.2%，P=.002）和并发症发生率（14.1%与 10.5%，P=.040）均显著更高，术后 3 个月和 12 个月的再入院率也显著更高。在控制年龄和基线合并症后，PD 患者与非 PD 患者相比，再次手术的可能性高 1.64 倍（95%CI 1.10-2.37；P=.012），在评估初次肩关节炎置换术后无翻修生存时，再次手术的风险比为 1.54（95%CI 1.07-2.20；P=.019）。
PD 使 TSA 患者的住院时间延长、术后并发症和翻修率增加、住院费用增加。了解此类人群的相关风险和资源需求将有助于外科医生在为越来越多的 PD 患者提供治疗时做出决策。
