Revision Thumb Carpometacarpal Joint Arthroplasty: Risk Factors and Health Care Economic Implications

The risk factors and financial implications of revision thumb carpometacarpal joint (CMC) arthroplasty are unclear. The authors aimed to identify risk factors for revision thumb CMC surgery and how CMC surgery affects health care cost and utilization.

The authors conducted a retrospective longitudinal analysis using a nationwide claims database, the Optum de-identified Clinformatics Data Mart, between October 1, 2015, and December 31, 2018. Health care utilization and costs were measured from 1 year preoperatively to 3 years postoperatively. Generalized linear mixed-effects models with propensity score weighting were applied to evaluate the association between health care cost and utilization and revision surgery. Multivariable logistic regression was used to find associations between revision surgery and preoperative characteristics.

A total of 4788 patients (94.6%) underwent only primary CMC arthroplasty, and 271 patients (5.7%) underwent revision surgery. Compared with the primary surgery group, the revision group incurred an average additional $420 in total health care costs at 1 year after surgery (95% CI, $275.74, $564.77 [ P = 0.01]) and $3878 at 2 years (95% CI, $3732.50, $4028.80). Similarly, health care utilization was an average of 20% higher at 2 years after surgery in the revision group (95% CI, 1.09, 1.31) and 57% higher at 3 years (95% CI, 1.42, 1.75). The odds of revision increased by 51% (95% CI, 1.04, 1.98) among patients younger than 55 years and by 40% among patients with chronic pain diagnosis (95% CI, 1.08, 1.72).

Revision CMC arthroplasty required more yearly health care expenditure and utilization compared with primary CMC arthroplasty. Patients younger than 55 years at the time of initial surgery and patients with chronic pain were more likely to undergo revision CMC arthroplasty. Preoperative expectation management in these patients is crucial.