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Comparing Reported Complication Rates in Shoulder Arthroplasty Between 2 Large Databases.

Matthew J Salzler, Ian D Engler, Andrew X Li

    Orthopedics
    |January 14, 2020
    PubMed
    Summary

    Shoulder arthroplasty complication rates differ significantly between the Nationwide Inpatient Sample (NIS) and National Surgical Quality Improvement Program (NSQIP) databases. These discrepancies persist even when comparing data from the same hospitals, highlighting database design impacts.

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    Area of Science:

    • Orthopedic Surgery
    • Health Services Research
    • Data Science in Healthcare

    Background:

    • Large healthcare databases are crucial for analyzing surgical outcomes and quality.
    • Previous research indicates variability in complication rates across different databases for specific procedures.
    • The underlying reasons for these database-specific differences in surgical outcomes remain unclear.

    Purpose of the Study:

    • To compare complication rates for shoulder arthroplasty between two major databases: NIS and NSQIP.
    • To investigate potential causes for observed differences in complication reporting.
    • To assess the impact of database design on reported surgical outcomes.

    Main Methods:

    • Retrospective comparison of shoulder arthroplasty complication data from 2006-2010.
    • Utilized data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) and the American College of Surgeons National Surgical Quality Improvement Program (NSQIP).
    • Restricted NIS data to hospitals also contributing to NSQIP for a more direct patient population comparison.

    Main Results:

    • Shoulder arthroplasty complication rates were significantly higher in NIS (12.6%) compared to NSQIP (5.60%).
    • Even when analyzing NIS data from hospitals participating in NSQIP, complication rates remained higher (13.4%).
    • This suggests database design, rather than solely patient population differences, influences reported complication rates.

    Conclusions:

    • Statistically significant differences exist in reported shoulder arthroplasty complication rates between NIS and NSQIP.
    • The persistence of these differences, even within the same hospitals, points to database design as a key factor.
    • Clinicians and administrators should exercise caution when interpreting complication rates from large database studies.