These authors sought to determine patient-level drivers of lower costs and improved health-related quality of life (HRQoL) in 2 anatomic shoulder arthroplasty procedures: ream-and-run arthroplasty (RnR N=211) and anatomic total shoulder arthroplasty (aTSA N=222).
As can be seen from the below, there were important differences in the patients having the two procedures, including sex, age, BMI, ASA class, insurance, diagnosis, glenoid type, prior surgery, opioid use, diabetes, preoperative simple shoulder test scores, and preoperative physical and mental function,
The preoperative and postoperative scores for the two procedures are shown below,
In the aTSA group, female sex, lower American Society of Anesthesiologists class, diagnosis other than capsulorrhaphy arthropathy, lower pain score, and higher Single Assessment Numeric Evaluation score were associated with decreased total hospitalization costs; in addition, female sex was an independent predictor of lower total costs.
Insurance other than workers’ compensation, a diagnosis of chondrolysis, and higher optimism led to greater QALY gains, but a diagnosis of capsulorrhaphy arthropathy was the only independent predictor of greater QALY gains with aTSA
In the ream-and-run arthroplasty group, older age, lower body mass index (BMI), lower American Society of Anesthesiologists class, insurance other than Medicaid, diagnosis other than capsulorrhaphy arthropathy, no history of surgery, higher preoperative Simple Shoulder Test score, and higher preoperative Short Form 36 Physical Component Summary score were associated with lower total costs; moreover, lower BMI was an independent predictor of lower costs.
Higher preoperative optimism was an independent predictor of greater QALY gains with the RnR.
This study identified fixed (sex and diagnosis) and modifiable (BMI) factors that drive decreased hospitalization costs and increased HRQoL improvements in shoulder arthroplasty patients. Higher preoperative patient optimism was a consistent predictor of improved HRQoL for both TSA patients and ream-and-run arthroplasty patients.
Comment: This large single-center study assessed the factors associated with inpatient costs and quality of life for patients having two types of anatomic shoulder arthroplasty: total shoulder and ream and run. It is evident that the two patient populations differ in substantial ways, so this study does not compare costs and QALYs for the two procedures when applied to comparable patients. It does, however provide useful data for the important drivers of cost and QALY within in group. Important, it calls attention to the importance of the patient's preoperative optimism as a driving factor for improvement in the quality of life. For the optimism score, the patient simply indicated his or her optimism for a positive outcome from surgery on a 0 to 10 scale, on which 10 was maximally optimistic.
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