Impact of depressive disorders on primary total shoulder arthroplasties: a matched control analysis of 113,648 Medicare patients

Introduction The purpose of this study was to investigate whether patients with depressive disorders undergoing primary total shoulder arthroplasty have higher rates of (1) in-hospital lengths of stay, (2) readmission rates, (3) medical complications, and (4) implant-related complications. Methods A retrospective query was performed using a national claims database. Study group patients were matched to controls in a 1:5 ratio according to age, sex, and medical comorbidities. The query yielded 113,648 patients who were with (n = 18,953) and without (n = 94,695) depressive disorders. Pearson’s χ 2 analyses were used to compare patient demographics. Logistic regression analyses were used to calculate odds-ratios of complications and readmission rates. Welch’s t-tests were used to test for significance for in-hospital lengths of stay. A p-value less than 0.003 was considered statistically significant. Results Study group patients had significantly longer in-hospital lengths of stay (2.7 days versus 2.3 days; p < 0.0001). Patients who have depressive disorders had higher incidences and odds of readmissions (9.4 versus 6.15%; odds-ratio: 1.6, p < 0.0001), medical complications (2.7 versus 0.9%; odds-ratio: 3.0, p < 0.0001), and implant-related complications (6.1 versus 2.4%; odds-ratio: 2.59, p < 0.0001) compared to controls. Conclusion Depressive disorder patients have longer in-hospital lengths of stay and increased odds of readmissions and complications following primary total shoulder arthroplasty.

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Implant-related complications in patients with opioid use disorder undergoing primary shoulder arthroplasties: a matched-controlled analysis

Shoulder & Elbow ◽

10.1177/1758573221994790 ◽

2021 ◽

pp. 175857322199479

Author(s):

Samuel J Swiggett ◽

Matthew L Ciminero ◽

Miriam D Weisberg ◽

Rushabh M Vakharia ◽

Ramin Sadeghpour ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Healthcare Providers ◽

Opioid Use Disorder ◽

P Value ◽

Opioid Use ◽

Readmission Rates ◽

Costs Of Care ◽

Lengths Of Stay ◽

Shoulder Arthroplasties ◽

Medicare Database

Background The purpose of this study was to investigate whether patients undergoing primary shoulder arthroplasty with opioid use disorder have higher rates of (1) implant-related complications; (2) in-hospital lengths of stay; (3) readmission rates; and (4) costs of care. Methods Opioid use disorder patients undergoing primary shoulder arthroplasty were queried and matched in a 1:5 ratio to controls by age, sex, and medical comorbidities within the Medicare database. The query yielded 25,489 patients with ( n = 4253) and without ( n = 21,236) opioid use disorder. Primary outcomes analyzed included: 2-year implant related complications, in-hospital lengths of stay, 90-day readmission rates, and 90-day costs of care. A p value less than 0.01 was considered statistically significant. Results Opioid use disorder patients had significantly longer in-hospital lengths of stay (3 days vs. 2 days; p < 0.0001) compared to matched controls. Opioid use disorder patients were also found to have higher incidence and odds (OR) of readmission rates (12.84 vs. 7.45%; OR: 1.16, p < 0.0001) and implant-related complications (20.03 vs. 7.95%; OR: 1.82, p < 0.0001). Study group patients also incurred significantly higher 90-day costs of care ($16,918.85 vs. $15,195.37, p < 0.0001). Discussion This study can be used to help further augment efforts to reduce opioid prescriptions from healthcare providers in shoulder arthroplasty settings.

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Impact of Biological Sex on Complications, Lengths of Stay, Readmission Rates, and Costs of Care Following Primary Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0041-1723014 ◽

2021 ◽

Author(s):

Samuel J. Swiggett ◽

Angelo Mannino ◽

Rushabh M. Vakharia ◽

Joseph O. Ehiorobo ◽

Martin W. Roche ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Primary Total Knee Arthroplasty ◽

Medical Complications ◽

Administrative Claims ◽

Readmission Rates ◽

Costs Of Care ◽

Lengths Of Stay ◽

Total Knee ◽

The Impact

AbstractThe impact of gender on total knee arthroplasty (TKA) postoperative complications, readmission rates, and costs of care has not been often evaluated. Therefore, the purpose of this study was to investigate which sex had higher rates of: (1) medical complications; (2) implant complications; (3) lengths of stay (LOSs); (4) readmission rates; and (5) costs after TKA. A query was performed using an administrative claims database from January 1, 2005, to March 31, 2015. Patients who had TKAs were identified using International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes. Males and females were filtered separately and matched according to age and various medical comorbidities leading to 1,590,626 patients equally distributed. Primary outcomes analyzed included 90-day medical complications, LOSs, 90-day readmission rates, in addition to day of surgery and total global 90-day episode of care costs. Pearson's chi-square analyses were used to compare medical complications and readmission rates. Welch's t-tests were used to test for significance in matching outcomes and costs. A p-value of less than 0.01 was considered statistically significant. Males had a smaller risk of complications than women (1.35 vs. 1.40%, p < 0.006) and higher rates of implant-related complications (2.28 vs. 1.99%, p < 0.0001). Mean LOSs were lower for males: 3.16 versus 3.34 days (p < 0.0001). The 90-day readmission rates were higher in men (9.67 vs. 8.12%, p < 0.0001). This study demonstrated that males undergoing primary TKA have lower medical complications and shorter LOSs then their female counterparts. However, males have higher implant-related complications, readmission rates, and costs of care.

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Medical Complications and Outcomes After Total Shoulder Arthroplasty: A Nationwide Analysis

The American Journal of Orthopedics ◽

10.12788/ajo.2018.0086 ◽

2018 ◽

Vol 47 (10) ◽

Cited By ~ 1

Author(s):

Oke A. Anakwenze ◽

Evan A. O’Donnell ◽

Charles M. Jobin ◽

William N. Levine ◽

Christopher S. Ahmad

Keyword(s):

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Medical Complications

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Outpatient total shoulder arthroplasty: a population-based study comparing adverse event and readmission rates to inpatient total shoulder arthroplasty

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2016.04.006 ◽

2016 ◽

Vol 25 (11) ◽

pp. 1780-1786 ◽

Cited By ~ 47

Author(s):

Timothy S. Leroux ◽

Bryce A. Basques ◽

Rachel M. Frank ◽

Justin W. Griffin ◽

Gregory P. Nicholson ◽

...

Keyword(s):

Adverse Event ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Population Based ◽

Readmission Rates ◽

Population Based Study

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Treatment Effects of Reverse Total Shoulder Arthroplasty – A Simple Method to Measure Outcomes at 6, 12, 24 and 60 Months for Each Patient

10.21203/rs.3.rs-17195/v4 ◽

2020 ◽

Author(s):

Joerg Huber ◽

Ulrich Irlenbusch ◽

Max J Kääb ◽

Falk Reuther ◽

Georges Kohut ◽

...

Keyword(s):

Treatment Effect ◽

Shoulder Arthroplasty ◽

Treatment Effects ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

P Value ◽

Simple Method ◽

The Mean ◽

Grade 3 ◽

Dominant Side

Abstract Background Although shoulder arthroplasty is less common than knee or hip arthroplasty, the number of procedures being performed is increasing rapidly. The treatment effect is a simple method to measure outcome of joint replacement. The method was applied to measure results of total hip/knee arthroplasty but not yet for shoulder arthroplasty. Methods Included were patients with unilateral cuff arthropathy (Hamada grades >=2) treated with reversed total shoulder arthroplasty (RSA) in this prospective multicenter study. The patients were assessed with the ASES questionnaire. The treatment effects (TE) was calculated for each patient. TE = score reduction/baseline score. A positive TE means amelioration, TE = 0 unchanged, and a negative TE means worse. The primary aim was to calculate the TE’s for RSA at 6, 12, 24, and 60 months postoperatively. The secondary aim was to analyze the influence of confounders (preoperative Hamada grade, age, gender, dominance, side of the affected shoulder, general co-morbidities measured using ASA grade). Results 203 patients were included for this analysis of whom 183 patients had a complete 2 year follow up. Two years postoperatively the mean ASES score augmented significant from 20.5 to 78.7 (p<0.001). The 2 year TE's ranged from 1 to 0.09. We had no patient with a negative TE. A higher Hamada grade was associated with better TE’s (Hamada grade 4+ vs. 2, p-value 0.042). For age and dominant side there were weak associations where those aged 80+ and dominant side had better TE’s. The patients with higher ASA grade had lower TE’s (ASA grade 4+ vs. 1, p-value 0.013). The mean TE’s were 0.77 at 6-months, 0.81 at 1 year, 0.76 at 2 years and 0.73 at 5 years. Conclusions The outcome for reverse shoulder arthroplasty can be measured with the treatment effect method; the 2 years TE's vary from 1 to 0.09. The mean treatment effects change little in the first five postoperative years (from 0.73 to 0.81). The confounders for better TE’s were: higher severity of cuff arthropathy (Hamada grade 3, 4 and 5), less co-morbidities (ASA Grade 1), higher age (80+) and dominant side. Gender did not influence the 2-year TE’s. Trial registration: Comité intercantonal d'éthique (Jura, Fribourg, Neuchâtel), number 01/2008, 24.09.2008

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Treatment Effects of Reverse Total Shoulder Arthroplasty – A Simple Method to Measure Outcomes at 6, 12, 24 and 60 Months for Each Patient

10.21203/rs.3.rs-17195/v2 ◽

2020 ◽

Author(s):

Joerg Huber ◽

Ulrich Irlenbusch ◽

Max J Kääb ◽

Falk Reuther ◽

Georges Kohut ◽

...

Keyword(s):

Treatment Effect ◽

Shoulder Arthroplasty ◽

Treatment Effects ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

P Value ◽

Simple Method ◽

The Mean ◽

Grade 3 ◽

Dominant Side

Abstract Background Although shoulder arthroplasty is less common than knee or hip arthroplasty, the number of procedures being performed is increasing rapidly. The treatment effect is a simple method to measure outcome of joint replacement. The method was applied to measure results of total hip/knee arthroplasty but not yet for shoulder arthroplasty. Methods Included were patients with unilateral cuff arthropathy (Hamada grades >=2) treated with reversed total shoulder arthroplasty (RSA) in this prospective multicenter study. The patients were assessed with the ASES questionnaire. The treatment effects (TE) was calculated for each patient. TE = score reduction/baseline score. A positive TE means amelioration, TE = 0 unchanged, and a negative TE means worse. The primary aim was to calculate the TE’s for RSA at 6, 12, 24, and 60 months postoperatively. The secondary aim was to analyze the influence of confounders (preoperative Hamada grade, age, gender, dominance, side of the affected shoulder, general co-morbidities measured using ASA grade).Results 203 patients were included for this analysis of whom 183 patients had a complete 2 year follow up. Two years postoperatively the mean ASES score augmented significant from 20.5 to 78.7 (p<0.001). The 2 year TE's ranged from 1 to 0.09. We had no patient with a negative TE. A higher Hamada grade was associated with better TE’s (Hamada grade 4+ vs. 2, p-value 0.042). For age and dominant side there were weak associations where those aged 80+ and dominant side had better TE’s. The patients with higher ASA grade had lower TE’s (ASA grade 4+ vs. 1, p-value 0.013). The mean TE’s were 0.77 at 6-months, 0.81 at 1 year, 0.76 at 2 years and 0.73 at 5 years. Conclusions The outcome for reverse shoulder arthroplasty can be measured with the treatment effect method; the 2 years TE's vary from 1 to 0.09. The mean treatment effects change little in the first five postoperative years (from 0.73 to 0.81). The confounders for better TE’s were: higher severity of cuff arthropathy (Hamada grade 3, 4 and 5), less co-morbidities (ASA Grade 1), higher age (80+) and dominant side. Gender did not influence the 2-year TE’s. Trial registration: Comité intercantonal d'éthique (Jura, Fribourg, Neuchâtel), number 01/2008, 24.09.2008

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Opioid Use Disorder in Patients Undergoing Primary 1- to 2-Level Anterior Cervical Discectomy and Fusion Is Associated With Longer In-Hospital Lengths of Stay and Higher Rates of Readmissions, Complications, and Costs of Care

Global Spine Journal ◽

10.1177/21925682211037265 ◽

2021 ◽

pp. 219256822110372

Author(s):

Nathan S. Kim ◽

Aaron W. Lam ◽

Ivan J. Golub ◽

Bhavya K. Sheth ◽

Rushabh M. Vakharia ◽

...

Keyword(s):

Opioid Use Disorder ◽

Anterior Cervical Discectomy ◽

Medical Complications ◽

Opioid Use ◽

Readmission Rates ◽

Cervical Discectomy ◽

Lengths Of Stay ◽

Episode Of Care ◽

Safe Discontinuation ◽

Medicare Database

Study Design: Retrospective study. Objective: To determine whether opioid use disorder (OUD) patients undergoing 1- to 2-level anterior cervical discectomy and fusion (1-2ACDF) have higher rates of: 1) in-hospital lengths of stay (LOS); 2) readmissions; 3) complications; and 4) costs. Methods: OUD patients undergoing primary 1-2ACDF were identified within the Medicare database and matched to a control cohort in a 1:5 ratio by age, sex, and medical comorbidities. The query yielded 80,683 patients who underwent 1-2 ACDF with (n = 13,448) and without (n = 67,235) OUD. Outcomes analyzed included in-hospital LOS, 90-day readmission rates, 90-day medical complications, and costs. Multivariate logistic regression analyses were used to calculate odds-ratios (OR) for medical complications and readmissions. Welch’s t-test was used to test for significance for LOS and cost between the cohorts. An alpha value less than 0.002 was considered statistically significant. Results: OUD patients were found to have significantly longer in-hospital LOS compared to their counterparts (3.41 vs. 2.23-days, P < .0001), in addition to higher frequency and odds of requiring readmissions (21.62 vs. 11.57%; OR: 1.38, P < .0001). Study group patients were found to have higher frequency and odds of developing medical complications (0.88 vs. 0.19%, OR: 2.80, P < .0001) and incurred higher episode of care costs ($20,399.62 vs. $16,812.14, P < .0001). Conclusion: The study can help to push orthopaedic surgeons in better managing OUD patients pre-operatively in terms of safe discontinuation and education of opioid drugs and their effects on complications, leading to more satisfactory outcomes.

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Modified frailty index predicts medical complications, length of stay, readmission, and mortality following total shoulder arthroplasty

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2019.03.009 ◽

2019 ◽

Vol 28 (10) ◽

pp. 1854-1860 ◽

Cited By ~ 8

Author(s):

Sophia A. Traven ◽

Kathy M. McGurk ◽

Russell A. Reeves ◽

Zeke J. Walton ◽

Shane K. Woolf ◽

...

Keyword(s):

Length Of Stay ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Frailty Index ◽

Medical Complications ◽

Modified Frailty Index

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A nationwide analysis on the effects of chronic obstructive pulmonary disease following primary total shoulder arthroplasty for glenohumeral osteoarthritis

Shoulder & Elbow ◽

10.1177/1758573221993828 ◽

2021 ◽

pp. 175857322199382

Author(s):

Brandon Amirian ◽

Kyrillos M Akhnoukh ◽

Asad M Ashraf ◽

Samuel J Swiggett ◽

Francis E Rosato ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Length Of Stay ◽

Pulmonary Disease ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Medical Complications ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease

Background Chronic obstructive pulmonary disease patients have been shown in orthopedic literature to have poorer outcomes and higher rates of complications from surgery. In this retrospective review, medical complications, length of stay, and costs were obtained to explore the effects of chronic obstructive pulmonary disease on patients undergoing primary total shoulder arthroplasty. Methods Total shoulder arthroplasty cases from January 2005 to March 2014 were queried and analyzed from a nationwide database. Study patients were matched 1:5 to controls by age, sex, and medical comorbidities associated with chronic obstructive pulmonary disease. In-hospital length of stay, 90-day medical complications, day of surgery, and total global 90-day episode of care costs were obtained for comparison. Results Chronic obstructive pulmonary disease patients were found to have higher incidence and odds (53.91 vs. 11.95%; OR: 3.58, 95%CI: 3.18–3.92, p < 0.0001) of 90-day medical complications, longer in-hospital length of stay (3 vs. 2 days, p < 0.0001), and significantly higher 90-day costs ($14,768.37 vs. $13,379.20, p < 0.0001) following primary total shoulder arthroplasty compared to matched controls. Discussion Chronic obstructive pulmonary disease patients undergoing primary total shoulder arthroplasty have higher rates of medical complications, in-hospital length of stay, and costs of care. This represents an important factor that will allow orthopedic surgeons to adequately manage expectations and educate chronic obstructive pulmonary disease patients of the potential complications which may occur following total shoulder arthroplasty.

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Treatment Effects of Reverse Total Shoulder Arthroplasty for Unilateral Cuff Tear Arthropathy – Outcomes at 6, 12, 24 and 60 Months and Confounders

10.21203/rs.3.rs-17195/v1 ◽

2020 ◽

Author(s):

Jorg Huber ◽

Ulrich Irlenbusch ◽

Max J Kääb ◽

Falk Reuther ◽

Georges Kohut ◽

...

Keyword(s):

Treatment Effect ◽

Shoulder Arthroplasty ◽

Treatment Effects ◽

Total Shoulder Arthroplasty ◽

P Value ◽

Cuff Tear Arthropathy ◽

Simple Method ◽

Cuff Tear ◽

The Mean ◽

Dominant Side

Abstract Background Although shoulder arthroplasty is less common than knee or hip arthroplasty, the number of procedures being performed is increasing rapidly. The treatment effect is a simple method to measure outcome of joint replacement for each patient individually. The method was applied to measure outcome of total hip/knee arthroplasty but not yet for shoulder arthroplasty. Methods The patients with reversed total shoulder arthroplasty (RSA) of five European clinics were included in this prospective study. The treatment effects (TE) were calculated for each patient as complaint reduction/baseline complaints. 1 is the maximal treatment effect and corresponds to a patient without complaints. A positive number means amelioration, 0 = unchanged, a negative number means worse. The primary aim was to calculate the TE’s for RSA at 6, 12, 24, and 60 months postoperatively. The secondary aim was to analyze the influence of confounders (preoperative grade of cuff tear arthropathy, age, gender, dominance, side of the affected shoulder, general co-morbidities measured using ASA grade). Results 203 patients were included for this analysis of whom 183 patients had a complete 2 year follow up. Over the 24-months, the mean ASES score augmented significant from 20.5 to 78.7 (p<0.001). The 2 year treatment effects ranged from 1 to 0.09. We had no patient with a negative TE. A higher Hamada grade was associated with better TE’s (Hamada grade 4+ vs. 2, p-value 0.042). For age and dominant side there were weak associations where those aged 80+ and dominant side had better TE’s. The patients with higher ASA grade had lower TE’s (ASA grade 4+ vs. 1, p-value 0.013). The mean TE’s were 0.77 at 6-months, 0.81 12-months, 0.76 24-months and 0.73 at 60-months. Conclusions The treatment effects for reverse shoulder arthroplasty vary from 1 to 0.09. The treatment effects change little in the first five postoperative years (from 0.73 to 0.81). The confounders for better TE’s were: higher severity of cuff arthropathy (Hamada grade 3, 4 and 5), less co-morbidities (ASA Grade 1), higher age (80+) and dominant side. Gender did not influence the 2-year TE’s.

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