Friday, November 28, 2014

Total shoulder arthroplasty - the charges are rising

Factors affecting hospital charges after total shoulder arthroplasty: an evaluation of the National Inpatient Sample database.

These authors queried  the U.S. National Inpatient Sample database from1993-2010 to evaluate total hospital charges for shoulder arthroplasty. The total hospital charge increased from $7,000 in 1994 to $22,000 in 2010.

Increased charges were associated with the diagnoses of post-traumatic and rheumatoid arthritis, with comorbidities such asdiabetes, lung disease, heart disease, and kidney disease, with surgery in the western and southern regions of the United States, and with surgery at larger hospitals and private urban hospitals. Complications occurring during the hospital stay increased the total hospital charges: complications related to the procedure by about 20% while other complications by 27.34% to 60.47%.

The authors do not provide data on the effect of charges for total shoulder implants on the overall charges for shoulder arthroplasty.

Comment: While this study does not measure the effects of the different variables on the cost of providing total shoulder arthroplasty, it strongly suggests that shoulder and patient variables have major effects on the expenses that hospitals encounter. These variables will need to be considered in efforts to arrive at a 'bundled' payment for shoulder arthroplasty.


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