Causes of Shoulder Arthroplasty Hospital Readmissions

For patients with glenohumeral osteoarthritis, hospital readmission after total shoulder arthroplasty is more likely if they have greater comorbidities, a new study finds.

The study, “Comparison of patient-demographics, causes, and costs of 90-day readmissions following primary total shoulder arthroplasty for glenohumeral osteoarthritis,” was published in the May-June 2022 issue of The Journal of Orthopaedics.

“Readmissions following orthopaedic surgery are associated with worse outcomes and increased healthcare costs. Studies investigating trends, causes, and costs of readmissions following primary total shoulder arthroplasty for the indication of glenohumeral osteoarthritis are limited,” the researchers wrote.

For their study, the research team compared and contrasted the patient-demographics of those who were readmitted within 90-days of a primary shoulder arthroplasty and those who were not. Among the data collected were causes for readmission and the related costs.

The team then gathered data retrospectively from 2005 to 2014 using a nationwide administrative claims database. Causes of readmission were broken down into the following groups: cardiovascular, hematological, endocrine, gastrointestinal, musculoskeletal, neoplastic, neurological, pulmonary, infectious, renal, and miscellaneous causes.

The team discovered that the patients more likely to be readmitted were those over the age of 75 with a higher prevalence of comorbid conditions, including psychiatric and medical conditions. They are also more likely to be female.

The overall 90-day readmission rate was 2.4% (3,432/143,878). Readmitted patients had a higher overall comorbidity burden per mean Elixhauser-Comorbidity Index scores (10 vs. 7, p < .0001). The leading cause of readmissions were due to musculoskeletal (17.34%), cardiac (16.28%), infectious (16.26%), and gastrointestinal (11.64%) complications.

The researchers said there were differences in the mean 90-day cost of care between the difference reasons for readmission. The most expensive causes were cardiac ($10,913.70) and musculoskeletal ($10,590.50).

“Patients with greater comorbidities experienced increased incidence of readmission following total shoulder arthroplasty for glenohumeral osteoarthritis. Cardiac and musculoskeletal etiologies were the primary cause of readmission,” the researchers wrote.

Study authors include Marcos Vargas, Giovanni Sanchez, Adam M. Gordon, Andrew R. Horn, Charles A. Conway, Afshin E. Razi and Ramin Sadeghpour, all of Maimonides Medical Center.