Reverse shoulder arthroplasty for proximal humerus fractures and reverse shoulder arthroplasty for elective indications should have separate Current Procedural Terminology (CPT) codes

IF 2.9 2区医学 Q1 ORTHOPEDICS

Journal of Shoulder and Elbow Surgery Pub Date : 2024-10-18 DOI:10.1016/j.jse.2024.08.037

Amir M. Boubekri MD , Michael Scheidt MD , Hassan Farooq MD , William Oetojo BA , Krishin Shivdasani MD, MPH , Nickolas Garbis MD , Dane Salazar MD, MBA

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引用次数: 0

Abstract

Background

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.

Methods

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.

Results

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.

Discussion

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.

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因肱骨近端骨折而进行的反向肩关节置换术和因选择性适应症而进行的反向肩关节置换术应使用不同的现行程序术语 (CPT) 代码。

背景：针对骨折的反向肩关节置换术（RSA）目前与针对关节病的肩关节置换术共用一个现行手术术语（CPT）代码，尽管在患者因素、手术需求、术后护理和需求以及医院系统的整体资源利用方面存在潜在差异。我们假设，与因肩袖关节病而接受 RSA 的患者队列相比，因骨折而接受 RSA 的患者将具有更高的医疗复杂性、需要更长的手术时间、更高的并发症发生率、更差的功能预后以及更高的医疗成本支出。方法：我们对 2011 年 1 月至 2020 年 12 月期间的 383 例 RSA 进行了回顾性研究。对人口统计学、合并症、手术时间、财务费用和成本数据、住院时间（LOS）、出院处置和全因复查进行了评估。术后2、6和12个月对视觉模拟量表（VAS）疼痛评分和主动活动范围（AROM）进行评估：结果：共纳入 197 例 RSA，其中 28 例为骨折适应症，169 例为关节病适应症。骨折的RSA手术时间更长，平均为（143.2±33.7）分钟，而关节病的手术时间为（108.2±33.9）分钟（P=0.001）。每位肱骨近端骨折患者的平均RSA费用比选择性适应症的RSA费用高出2,489美元；但平均费用之间没有统计学差异（P=0.126）。与关节病相比，骨折用 RSA 的 LOS 更长，平均为 4.0 ± 3.6 天，而关节病为 1.8 ± 2.3 天（P=0.004）。骨折组患者出院后入住专业护理机构或住院康复中心的几率是其他组的3.6倍（32%对9%，P=0.002）。两组的早期和晚期全因复发率相似。术后2个月（95.5±36.7°，117.0±32.3°）和6个月（110.9±35.2°，129.2±28.3°）（p=0.020）以及主动内收外旋（aER）在 6 个月（20.0±20.9°，33.1±12.3°）（p=0.007）和 12 个月（23.3±18.1°，34.5±13.8°）（p=0.012）时的差异。骨折组和关节病组在任何时间点的 VAS 疼痛评分均无差异：讨论：RSA治疗骨折与关节病在患者特征、手术复杂性和医院资源利用方面存在很大差异。这一点非常重要，因为目前可用的 CPT 代码并未区分 RSA 的适应症，尤其是如果要准确记录所提供的手术护理的话。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Shoulder and Elbow Surgery 医学-外科

CiteScore

6.50

自引率

23.30%

发文量

604

审稿时长

11.2 weeks

期刊介绍： The official publication for eight leading specialty organizations, this authoritative journal is the only publication to focus exclusively on medical, surgical, and physical techniques for treating injury/disease of the upper extremity, including the shoulder girdle, arm, and elbow. Clinically oriented and peer-reviewed, the Journal provides an international forum for the exchange of information on new techniques, instruments, and materials. Journal of Shoulder and Elbow Surgery features vivid photos, professional illustrations, and explicit diagrams that demonstrate surgical approaches and depict implant devices. Topics covered include fractures, dislocations, diseases and injuries of the rotator cuff, imaging techniques, arthritis, arthroscopy, arthroplasty, and rehabilitation.