Saturday, November 1, 2014

Why not just do a reverse total shoulder?

Comparative analysis of anatomic and reverse total shoulder arthroplasty: in-hospital outcomes and costs

There has been a rapid rise in the number of reverse total shoulders done each year. Reverse shoulder arthroplasty accounted for 42% of all primary shoulder arthroplasty procedures in 2011. The concomitant diagnosis of osteoarthritis and rotator cuff impairment was found in only 29.8% of reverse shoulder arthroplasty cases.

These authors used the Nationwide Inpatient Sample database from 2011, the first year that reverse total shoulder arthroplasty received a unique ICD 9 procedure code, to locate an estimated 51,052 patients undergoing total shoulder arthroplasty. These were separated into anatomic total shoulder arthroplasty (58%) and reverse total shoulder arthroplasty (43%). 

In that 44% of the reverse total shoulders in this study were performed for the diagnosis of osteoarthritis, the authors raise concerns about the appropriateness of the indications for these procedures.

Patients having reverse total shoulders were older, more likely to be female, had lower income, were more likely to be on Medicaid, had more co-morbidities, had more medical complications and had higher hospital costs ($64,383 vs $53,006) than those having anatomic arthroplasty. They observed that implant costs were about $3,000 greater for the reverse total shoulder.

They found that reverse total shoulder was an independent risk factor for inpatient morbidity, mortality, and hospital costs. Even when the analysis was adjusted for age, gender, race, and comorbidities, patients undergoing reverse shoulder replacement were at higher risk for in-hospital death, multiple perioperative complications, prolonged hospital stay, increased hospital cost, and nonroutine discharge.

Comment:  The choice of procedure for an individual depends on the diagnosis, the patient's health and expectations, and the experience and judgment of the surgeon. It is a surprise that almost half of the shoulder arthroplasties being done these days are reverses. This is not our practice. In fact, we find that many patients referred to us for a reverse are better served by other options.

It will be interesting to see if this trend continues based on the assessed value of the procedure, or whether the increased cost vs. reimbursement and the more frequent adverse outcomes may start to swing the pendulum in the other direction.


To see the topics covered in this Blog, click here

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'