Factors associated with improvement in quality of life and inpatient costs for ream and run and anatomic shoulder arthroplasty.

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 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,

The cost, utility and QALY data 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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Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link)

Shoulder arthritis - x-ray appearance (see this link)

The smooth and move for irreparable cuff tears (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).

Shoulder rehabilitation exercises (see this link).

This is a non-commercial site, the purpose of which is education, consistent with "Fair Use" as defined in Title 17 of the U.S. Code.          

Note that author has no financial relationships with any orthopaedic companies.

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.

Our approach to the ream and run can be viewed by clicking here.

Our approach to total shoulder arthroplasty can be viewed by clicking here.

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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'