Frailty and comorbidity burden independently predict higher healthcare costs and nonhome discharges after total shoulder arthroplasty

Q2 Medicine

JSES International Pub Date : 2025-09-01 DOI:10.1016/j.jseint.2025.05.024

Cory K. Mayfield MD , Julian Wier MD , Kevin C. Liu MD , Eric H. Lin BA , Cailan L. Feingold BS , Alexander E. Weber MD , Seth C. Gamradt MD , Joseph N. Liu MD , Frank A. Petrigliano MD

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Abstract

Background

With an aging population, total shoulder arthroplasty (TSA) will more frequently be performed in older adults. Comorbidity burden and frailty are two distinct risk factors for adverse outcomes; however, their independent effect on outcomes after TSA is unknown. The aim of this study was to determine the effect of frailty and comorbidities on postoperative healthcare utilization after TSA.

Methods

Patients who underwent primary, elective anatomic or reverse TSA between January 1, 2016, and December 31, 2020, were identified using the Premier Healthcare Database. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups Frailty Index. Comorbidity burden was defined via the Elixhauser Comorbidity Index (unhealthy >2 comorbidities). These were then used to define healthy, frail, unhealthy, and frail/unhealthy patients. Rates of protracted (>2 days) length of stay (LOS), skilled nursing facility (SNF) discharges, and readmission were then compared between groups. Multivariable models were conducted to evaluate the adjusted effect of frailty and comorbidity burden.

Results

86,356 patients who underwent TSA were identified. 53,913 were categorized as healthy, 29,461 as unhealthy, 1,640 as frail, and 1,342 as frail/unhealthy. The frail/unhealthy cohort had the highest rates of protracted LOS (65.06%), SNF discharges (29.90%), and readmissions (5.00%). The frail cohort had higher rates of protracted LOS (48.96% vs. 39.78%) and SNF discharges (16.77% vs. 9.94%), with similar readmission rates (3.35% vs. 3.18%) when compared to the unhealthy group. These overall trends persisted after accounting for potential confounding factors.

Conclusion

When both present, frailty and comorbidity appear to be a major driver of increased healthcare utilization after TSA. These data can be used to guide patient expectations and illustrate the need for postoperative pathways for these patients.

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虚弱和合并症负担独立预测全肩关节置换术后更高的医疗费用和非家庭出院

背景：随着人口老龄化，全肩关节置换术（TSA）将更频繁地在老年人中进行。合并症负担和虚弱是不良结果的两个不同的危险因素；然而，它们对TSA后结果的独立影响尚不清楚。本研究的目的是确定虚弱和合并症对TSA术后医疗保健利用的影响。方法2016年1月1日至2020年12月31日期间接受原发性、选择性解剖或反向TSA的患者，使用Premier Healthcare Database进行识别。虚弱的定义采用约翰霍普金斯调整临床组虚弱指数。共病负担通过Elixhauser共病指数（不健康共病）定义。然后用这些来定义健康、虚弱、不健康和虚弱/不健康的患者。然后比较两组住院时间延长（2天）、熟练护理设施（SNF）出院率和再入院率。采用多变量模型评价虚弱和共病负担的调整效果。结果86,356例患者接受了TSA检查。53,913人属于健康，29,461人属于不健康，1,640人属于虚弱，1,342人属于虚弱/不健康。体弱/不健康队列的迟延LOS发生率最高（65.06%），SNF出院率最高（29.90%），再入院率最高（5.00%）。与不健康组相比，体弱多病组有更高的延期LOS发生率（48.96%对39.78%）和SNF出院率（16.77%对9.94%），再入院率相似（3.35%对3.18%）。在考虑到潜在的混杂因素后，这些总体趋势仍然存在。结论当两者同时存在时，虚弱和合并症似乎是TSA后医疗保健利用率增加的主要驱动因素。这些数据可以用来指导患者的期望，并说明这些患者术后路径的需要。

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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