Schick Samuel, Elphingstone Joseph, Murali Sudarsan, Carter Karen, Davis William, McGwin Gerald, Evely Thomas, Ponce Brent, Momaya Amit, Brabston Eugene
Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA.
JSES Int. 2023 Apr 11;7(4):636-641. doi: 10.1016/j.jseint.2023.03.013. eCollection 2023 Jul.
Periprosthetic joint infections (PJIs) are a major cause of morbidity after shoulder arthroplasty. Prior national database studies have estimated the trends of shoulder PJI up to 2012. Since 2012, the landscape of shoulder arthroplasty has changed drastically with the expanding popularity of reverse total shoulder arthroplasty. The dramatic growth in primary shoulder arthroplasties is likely paralleled with an increase of PJI case volume. The purpose of this study is to quantify the rise in shoulder PJIs and the economic stress they currently place on the American healthcare system as well as the toll they will incur over the coming decade.
The Nationwide Inpatient Sample database was queried for primary and revision anatomic total shoulder arthroplasty, reverse total shoulder arthroplasty, and hemiarthroplasty from 2011-2018. Multivariate regression was used to predict cases and charges through the year 2030 adjusted to 2021 purchasing power parity.
From 2011 to 2018, PJI was found to be 1.1% shoulder arthroplasties, from 0.8% (2011) to 1.4% (2018). Anatomic total shoulder arthroplasty experienced the greatest proportion of infections at 2.0%, followed by hemiarthroplasty at 1.0% and reverse total shoulder arthroplasty at 0.3%. Total hospital charges grew 324%, from $44.8 million (2011) to $190.3 million (2018). Our regression model projects 176% growth in cases and 141% growth in annual charges by 2030.
This study demonstrates the large economic burden that shoulder PJIs pose on the American healthcare system, which is predicted to reach nearly $500 million in charges annually by 2030. Understanding trends in procedure volume and hospital charges will be critical in evaluating strategies to reduce shoulder PJIs.
人工关节周围感染（PJI）是肩关节置换术后发病的主要原因。先前的全国性数据库研究已经估算出了截至2012年肩关节PJI的发病趋势。自2012年以来，随着反式全肩关节置换术日益普及，肩关节置换术的格局发生了巨大变化。初次肩关节置换术的急剧增长可能伴随着PJI病例数量的增加。本研究的目的是量化肩关节PJI的增长情况，以及它们目前给美国医疗系统带来的经济压力，以及在未来十年中将造成的损失。
查询2011年至2018年全国住院患者样本数据库中初次和翻修解剖型全肩关节置换术、反式全肩关节置换术和半肩关节置换术的数据。采用多变量回归来预测到2030年经2021年购买力平价调整后的病例数和费用。
2011年至2018年，PJI占肩关节置换术的1.1%，从2011年的0.8%升至2018年的1.4%。解剖型全肩关节置换术的感染比例最高，为2.0%，其次是半肩关节置换术，为1.0%，反式全肩关节置换术为0.3%。医院总费用增长了324%，从2011年的4480万美元增至2018年的1.903亿美元。我们的回归模型预测，到2030年病例数将增长176%，年费用将增长141%。
本研究表明，肩关节PJI给美国医疗系统带来了巨大的经济负担，预计到2030年每年的费用将接近5亿美元。了解手术量和医院费用的趋势对于评估减少肩关节PJI的策略至关重要。
