Khan Adam Z, Liu Harry H, Costouros John G, Best Matthew J, Fedorka Catherine J, Sanders Brett, Abboud Joseph A, Warner Jon J P, Fares Mohamad Y, Kirsch Jacob M, Simon Jason E, O'Donnell Evan A, Woodmass Jarret, Armstrong April D, Zhang Xiaoran, Beck da Silva Etges Ana Paula, Jones Porter, Haas Derek A, Gottschalk Michael B
Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Panorama City, CA, USA.
Avant-garde Health, Boston, MA, USA.
J Shoulder Elbow Surg. 2025 Apr;34(4):1120-1129. doi: 10.1016/j.jse.2024.07.033. Epub 2024 Sep 11.
Revision shoulder arthroplasty continues to add an increasing burden on patients and the healthcare system. This study aimed to delineate long-term shoulder arthroplasty revision incidence, quantify associated Medicare spending, and identify relevant predictors of both revision and spending.
The complete 2016-2022 (Q3) Medicare fee-for-service inpatient and outpatient claims data was analyzed. Patients receiving a primary total shoulder arthroplasty (TSA) for osteoarthritis, rotator cuff pathology, or inflammatory arthropathy were included and subsequent ipsilateral revision surgeries were identified. The time to revision was modeled using the Prentice, Williams, and Peterson Gap Time Model. Medicare spending within 90 days postdischarge was modeled using a generalized linear model. The analysis was subdivided by index procedure type: anatomic TSA and reverse shoulder arthroplasty (RSA).
A total of 82,949 primary TSAs and 172,524 RSAs were identified. Compared to index TSA cases, index RSA cases had a lower first revision rate in an observation window of nearly 7 years (1.9% vs. 3.5%, P < .001), but a higher rate of second (11.4% vs. 4.9%, P < .001) as well as third revision (13.8% vs. 13.8%, P = .449). TSA spending was significantly lower than RSA spending for the index procedure ($21,531 vs. $23,267, P < .001), first ($23,096 vs. $26,414, P < .001), and second ($25,060 vs. $29,983, P < .001) revision. There was no statistically significant difference in third revision between TSA and RSA groups ($31,313 vs. $30,829, P = .860). Age, sex, race, and rheumatoid arthritis were among the top predictors of revisions. Top predictors of Medicare spending included having a non-osteoarthritis surgical indication, a hospital stay of 3 or more days, a discharge to a setting other than home, malnutrition, dementia, stroke, major kidney diseases, and being operated on in a teaching hospital.
Compared with TSA, RSA was associated with a lower first revision rate, but a higher subsequent revision rate. An index RSA procedure was also associated with higher initial Medicare spending as well as subsequent revision surgery spending compared with an index TSA procedure. Demographics and comorbid medical conditions were among the top predictors of revisions, while procedure-related factors predicted Medicare spending.
肩关节置换翻修术给患者和医疗系统带来的负担日益加重。本研究旨在明确肩关节置换翻修术的长期发生率，量化相关医疗保险支出，并确定翻修和支出的相关预测因素。
分析了2016年至2022年（第三季度）完整的医疗保险按服务收费的住院和门诊理赔数据。纳入因骨关节炎、肩袖病变或炎性关节病接受初次全肩关节置换术（TSA）的患者，并确定随后的同侧翻修手术。使用普伦蒂斯、威廉姆斯和彼得森间隔时间模型对翻修时间进行建模。使用广义线性模型对出院后90天内的医疗保险支出进行建模。分析按初次手术类型细分：解剖型TSA和反肩关节置换术（RSA）。
共确定了82949例初次TSA和172524例RSA。与初次TSA病例相比，在近7年的观察期内，初次RSA病例的首次翻修率较低（1.9%对3.5%，P < 0.001），但二次翻修率较高（11.4%对4.9%，P < 0.001）以及三次翻修率（13.8%对13.8%，P = 0.449）。初次手术时TSA的支出显著低于RSA（21531美元对23267美元，P < 0.001），首次翻修时（23096美元对26414美元，P < 0.001）和二次翻修时（25060美元对29983美元，P < 0.001）也是如此。TSA组和RSA组在三次翻修时无统计学显著差异（31313美元对30829美元，P = 0.860）。年龄、性别、种族和类风湿关节炎是翻修的主要预测因素。医疗保险支出的主要预测因素包括有非骨关节炎手术指征、住院3天或更长时间、出院后不是回家、营养不良、痴呆、中风、严重肾脏疾病以及在教学医院接受手术。
与TSA相比，RSA的首次翻修率较低，但随后的翻修率较高。与初次TSA手术相比，初次RSA手术还与更高的初始医疗保险支出以及随后的翻修手术支出相关。人口统计学和合并症是翻修率的主要预测因素，而与手术相关的因素则预测医疗保险支出。
