The associations of comorbidities with healthcare utilization among patients undergoing total shoulder arthroplasty

Abstract

Background

Patients who undergo total shoulder arthroplasty (TSA) often have chronic comorbidities such as obesity, hypertension, and diabetes. Management of these comorbidities and their associated complications can lead to increased utilization of hospital resources, increasing the cost of care and the length of patients' hospital stay. Because the rate of TSAs is increasing, it is important for physicians and policymakers to understand which patient factors may contribute to healthcare utilization and to develop protocols that may address those factors or inform reimbursements. Using length of stay (LOS), hospital charges (HC), and hospital costs (HCo) as a proxy for healthcare utilization, our study asked whether, for patients undergoing TSA, there is an association between these measures and patient comorbidities.

Methods

A national database was queried for patients who underwent primary TSA from 2012 to 2020. A total of 31 comorbidities were classified using the Elixhauser Comorbidity Index. People with the comorbidity metastatic cancer were excluded. For each comorbidity of interest, patients were matched to another patient in the database by age, sex, and all other comorbidities except the comorbidity of interest. Matched cohorts were analyzed via multivariable regression analyses controlled for age, sex, year of procedure, hospital location, and comorbidities to predict differences in LOS, HC, and HCo.

Results

A total of 157,034 TSAs were included. Mean HC, HCo, and LOS were $74,974, $19,733, and 1.7 days, respectively. When comparing patients with analyzed comorbidities to those without, all comorbidities except smoking, tumor, renal or liver disease, and HIV/AIDS were associated with longer LOS; paralysis, pulmonary hypertension, weight loss, and fluid and electrolyte disorders were associated with 34%, 28%, 24%, and 23% greater odds of having an LOS ≥3 days (all P < .001); and weight loss, blood loss anemia, and coagulopathy were associated with 11%, 10%, and 5% greater HC, respectively (P = .039, .002, .024). Weight loss, pulmonary hypertension, and lymphoma were associated with 11%, 8%, and 6% greater HCo, respectively (P = .014, .021, .046), than in patients without those comorbidities.

Conclusion

This study offers targets for reduction of HC, HCo, and LOS for patients with these modifiable and nonmodifiable ailments through protocol change. Optimization programs targeting malnourished patients and patients with pulmonary hypertension and other comorbidities are encouraged. These results provide clinicians a quantifiable way to communicate financial burden and recovery time after TSA. Future research could investigate the synergistic effects of these comorbidities.