Reverse shoulder arthroplasty for proximal humerus fractures and reverse shoulder arthroplasty for elective...

Reverse shoulder arthroplasty (RSA) for fracture currently shares a single Current Procedural Terminology (CPT) code with RSA for arthropathy despite potential differences in patient factors, procedural demands, postoperative care and needs, and overall hospital systems' resource utilization. We hypothesize that patients indicated for RSA for fracture will have greater medical complexity, require longer operative duration, have higher complication rates, demonstrate inferior functional outcomes, and require greater health care cost expenditures compared to a cohort undergoing RSA for rotator cuff arthropathy.

A total of 383 RSAs were retrospectively reviewed from January 2011 to December 2020. Demographics, comorbidities, operative time, financial charge and cost data, length of stay (LOS), discharge disposition, and all-cause revisions were assessed. Visual analog scale (VAS) pain score and active range of motion (AROM) were evaluated at 2, 6, and 12 months postoperatively.

After exclusions, 197 total RSAs were included, with 28 for fracture and 169 for arthropathy indications. RSA operative time was longer for fractures with an average of 143.2 ± 33.7 minutes compared with 108.2 ± 33.9 minutes for arthropathy (P = .001). Average cost per patient for RSA for proximal humerus fracture was $2489 greater than the cost for RSA for elective indications; however, no statistically significant difference was noted between average costs (P = .126). LOS was longer for RSA for fracture compared to arthropathy, with a mean of 4.0 ± 3.6 days vs. 1.8 ± 2.3 days (P = .004). The fracture group was 3.6 times more likely to be discharged to a skilled nursing facility or inpatient rehabilitation (32% vs. 9%, P = .002). Early and late all-cause revisions were similar between groups. Differences in postoperative AROM for fracture vs. arthropathy were significant for active forward flexion at 2 months (95.5° ± 36.7° vs. 117.0° ± 32.3°, P = .020) and 6 months (110.9° ± 35.2° vs. 129.2° ± 28.3°, P = .020) as well as active adducted external rotation at 6 months (20.0° ± 20.9° vs. 33.1° ± 12.3°, P = .007) and at 12 months (23.3° ± 18.1° vs. 34.5° ± 13.8°, P = .012). No difference in VAS pain scores were noted between fracture and arthropathy groups at any time point.

RSA for fractures vs. arthropathy have substantial differences in patient characteristics, surgical complexity, and hospital resource utilization. This is of importance given the currently available CPT code does not differentiate indications for RSA, especially if intending to accurately document the surgical care delivered.