Total shoulder and ream and run: the importance of patient optimism.

Drivers of Lower Inpatient Hospital Costs and Greater Improvements in Health-Related Quality of Life for Patients Undergoing Total Shoulder and Ream-and-Run Arthroplasty

These authors sought to determine the patient factors associated with lower costs and improved health-related quality of life (HRQoL) in two anatomic shoulder arthroplasty procedures – total shoulder arthroplasty (TSA, n=222) and ream-and-run arthroplasty (n=211).

For the optimism score, the patient indicated his or her optimism for a positive outcome from surgery on a 0 to 10 scale, on which 10 was maximally optimistic.

In the TSA group, total hospital costs were lower for female sex, lower ASA score, diagnoses other than capsulorrhaphy arthropathy, lower pain scores, and higher SANE scores. Female sex was an independent predictor of lower total costs. 

Greater QALY gains were associated with insurance other than worker’s compensation, diagnosis of chondrolysis, and higher optimism. A diagnosis of capsulorrhaphy arthropathy was the only independent predictor of greater QALY gains. 

In the ream-and-run group, lower total costs were associated with older age, lower BMI, lower ASA score, insurance other than Medicaid, diagnoses other than capsulorrhaphy arthropathy, no history of previous surgery, higher preoperative SST scores, and higher preoperative SF-36 physical component summary scores were associated with lower total costs. Lower BMI was an independent predictor of lower costs. 

Greater QALY gains were independently associated with higher preoperative optimism.

Comment: This study is important in that it identifies factors associated with lower costs and greater improvements in quality of live. Of particular interest is the predictive value of a simple assessment of the patient's preoperative optimism.

The really interesting questions are (1) whether optimism should be considered in decision making and (2) whether preoperative optimism is a modifiable factor.

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