Saturday, May 15, 2021

Total shoulder arthroplasty - what do hospital rankings tell us about quality and cost?

Total Shoulder Arthroplasty (TSA) at U.S. News & World Report Top-Ranked Hospitals in Orthopaedics – Do Rankings Correlate with Complications and Cost?

The U.S. News & World Report (USNWR) hospital rankings remain the most publicly referenced system for identifying "top" hospitals for each specialty. These authors sought to evaluate whether there are any differences in outcomes and costs for patients undergoing anatomic TSA (ATSA) or reverse TSA (RTSA) for degenerative pathologies at ranked (n=68) vs. nonranked hospitals (n=2,632)

A total of 82,417 TSAs were included in the study – out of which 8,868 (10.8%) were performed in one of the 68 hospitals that were ranked by the USNWR between 2011 and 2014. 73,549 arthroplasties were performed at unranked hospitals. 

Following adjustment for baseline demographics, and clinical characteristics, there were no statistically significant differences between ranked vs. non-ranked hospitals, with regards to rates of infectious complications, dislocations, peri-prosthetic fractures, pulmonary embolism, deep venous thrombosis, myocardial infarction, sepsis, urinary tract infections, and readmissions

Ranked hospitals were more likely to be in the Northeast, while unranked hospitals were more likely to be the South and West.

Unranked hospitals had higher percentages of patients with median household income <$36,250 and were more likely to be located in a rural setting.

Ranked hospitals, however, did have higher risk adjusted charges (+ $6,167; P < 0.001), and costs (+ $1.831; P < 0.001) across the entire episode of care.

The authors concluded that patients undergoing TSAs at ranked hospitals vs. non-ranked

hospitals have similar outcomes, despite the former facilities having higher costs and charges

across the episode of care.

Comment: These results are reassuring: they indicate that quality surgical care for patients needing shoulder arthroplasty are being achieved at the 90% of medical centers that do not appear in the US News ranks, including those that serve less well-to-do patients.

Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The total shoulder arthroplasty (see this link).
The ream and run technique is shown in this link.
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).