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The following is a summary of “Revision Shoulder Arthroplasty: Predictors of Subsequent Revision Surgery and Economic Burden amongst Medicare Beneficiaries,” published in the October 2024 issue of Surgery by Peterson et al.
The growing incidence of revision shoulder arthroplasty is significantly burdening patients and the healthcare system. This study aimed to evaluate long-term revision rates following primary shoulder arthroplasty, analyze associated Medicare expenditures, and identify key revision and healthcare spending predictors.
Using comprehensive Medicare fee-for-service claims data from 2016 through the third quarter of 2022, researchers analyzed patients who underwent primary total shoulder arthroplasty (TSA) for osteoarthritis, rotator cuff pathology, or inflammatory arthropathy. Ipsilateral revision surgeries were tracked over time. The Prentice, Williams, and Peterson Gap Time Model was employed to estimate the time to revision, and a generalized linear model was applied to assess Medicare spending within 90 days of post-discharge. The analysis was stratified by the type of index procedure—anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA).
The study identified a total of 82,949 primary TSA and 172,524 RSA procedures. Patients who underwent RSA exhibited a lower rate of first revision over the nearly 7-year observation period compared to TSA (1.9% vs. 3.5%, p<0.001), but patients with RSA experienced significantly higher rates of second (11.4% vs. 4.9%, p<0.001) and third revisions (13.8% vs. 13.8%, p=0.449). Medicare expenditures were lower for TSA than for RSA across all stages of care: initial procedures ($21,531 vs. $23,267, p<0.001), first revision ($23,096 vs. $26,414, p<0.001), and second revision ($25,060 vs. $29,983, p<0.001). However, no significant cost difference was found in the third revision ($31,313 vs. $30,829, p=0.860). Key predictors of revision surgery included age, sex, race, and a diagnosis of rheumatoid arthritis. Factors contributing to increased Medicare spending included surgical indications unrelated to osteoarthritis, prolonged hospital stays, discharge to non-home settings, malnutrition, dementia, stroke, major kidney diseases, and surgeries performed in teaching hospitals.
In conclusion, RSA was associated with a lower initial revision rate but higher subsequent revision rates than TSA. Additionally, patients with RSA incurred higher Medicare costs for both initial procedures and revision surgeries. Demographic and clinical factors were identified as significant predictors of revision rates, while procedural and hospital-related factors largely influenced Medicare spending. These findings underscore the need for targeted strategies to manage costs and improve outcomes in shoulder arthroplasty.
Source: sciencedirect.com/science/article/abs/pii/S1058274624006268
