Same reimbursement, different cost: risk factors for high-cost total shoulder arthroplasty

Anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA) are effective procedures for a variety of shoulder pathologies, but reimbursement for these procedures is currently independent of hospital cost and nonmodifiable patient risk profile. This study investigates the association between patient and hospital factors, implant type, and postoperative complications with high hospitalization cost for total shoulder arthroplasty.

Data was obtained from the Premiere database. Patient demographic variables, hospital factors, and postoperative complications were collected. Patients were stratified into 2 groups to identify factors associated with high-cost surgery. The high-cost group included patients whose admission cost was greater than one standard deviation above the mean admission cost for the whole cohort.

A total of 144,725 patients were analyzed. The mean cost of hospital stay was $72,237.44 (standard deviation = $40,522.92). High-cost status was defined as >$122,760.36. Patients who underwent rTSA were over twice as likely to be in the high-cost group than patients who underwent aTSA (P < .0001). Surgical indications including proximal humerus fracture were independently associated with high cost (P < .0001) both for aTSA and rTSA. Patients with a history of obesity, electrolyte imbalances, and drug use were more likely to incur high surgical cost (P < .05). Patients in the West were most likely to be in the high-cost group and patients in the Midwest were more likely to be in the low-cost group (P < .0001).

Surgical implant type, indication, patient comorbidities, and hospital factors contribute to differential surgical cost for total shoulder arthroplasty. The present data may allow providers to identify patients at risk of incurring elevated hospital charges and who therefore may require increased reimbursement given increased perioperative complexity or specialized perioperative care to mitigate the risk of complications.