These authors sought to achieve an accurate understanding of surgical costs for shoulder arthroplasty along with preoperative correlates for high-cost patients. They used time-driven activity-based costing to explore inpatient cost of total shoulder arthroplasty and to identify preoperative characteristics of high-cost patients.
They calculated the cost of inpatient care for 415 patients undergoing elective primary TSA between 2016 and 2017. Patients in the top decile of cost were defined as high-cost patients.
Implant purchase price was the main driver (57%) of total inpatient costs, followed by personnel cost from patient check-in through the time in the operating room (20%).
There was a 1.3-fold variation in total cost between patients in the 90th percentile for cost and those in the 10th percentile; the widest cost variation was in personnel cost from the post-anesthesia care unit through discharge (2.5-fold) and in medication cost (2.4-fold).
High-cost patients were more likely to be women and chronic opioid users and to have diabetes, depression, an ASA score of 3 or more, a higher body mass index (BMI), and a lower preoperative ASES score than non-high-cost patients.
After multivariable adjustment, the 3 predictors of high-cost patients were female sex, an ASA score of 3 or more, and a lower ASES score.
Total inpatient cost correlated strongly with the length of the hospital stay but did not correlate with operative time.
They concluded that from a hospital’s perspective, efforts to reduce implant purchase prices may translate into rapid substantial cost savings.
They concluded that from a hospital’s perspective, efforts to reduce implant purchase prices may translate into rapid substantial cost savings.
At the patient level, multidisciplinary initiatives aimed at reducing length of stay and controlling medication expenses for patients at risk for high cost (e.g., infirm women with poor preoperative shoulder function) may prove effective in narrowing the existing patient-to-patient variation in costs.
Conclusion: This is an important analysis of some of the factors determining the costs of total shoulder arthroplasty. The authors suggest that cost saving strategies may include negotiating to lower implant costs and avoiding performing surgery on "high-cost" patients. Surgeons and hospitals may wish to consider their approaches to the management of patients in the "high-cost" group (female patients, those with high ASA scores and those with low preoperative shoulder function).
Conclusion: This is an important analysis of some of the factors determining the costs of total shoulder arthroplasty. The authors suggest that cost saving strategies may include negotiating to lower implant costs and avoiding performing surgery on "high-cost" patients. Surgeons and hospitals may wish to consider their approaches to the management of patients in the "high-cost" group (female patients, those with high ASA scores and those with low preoperative shoulder function).
Other preoperative factors might well be included in an analysis of the total cost of shoulder arthroplasty, including the incremental costs associated with different forms of preoperative shoulder imaging (plain films vs CT scans), the use of computerized preoperative planning, and the use of patient specific instrumentation.
Our overarching goal should be to make shoulder arthroplasty affordable for the individuals who are most likely to benefit from it.
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We have a new set of shoulder youtubes about the shoulder, check them out at this link.
Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link
Use the "Search" box to the right to find other topics of interest to you.
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We have a new set of shoulder youtubes about the shoulder, check them out at this link.
Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link
Use the "Search" box to the right to find other topics of interest to you.
How you can support progress in shoulder surgery
You may be interested in some of our most visited web pages arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
