Incidence of 30- and 90-day readmission rates after revision shoulder arthroplasty in the United States

Background

The incidence of shoulder arthroplasty is increasing at an exponential rate. This comes with an inherently associated increase in revision shoulder arthroplasty. Due to the increasing prevalence of revision surgery, combined with a decrease in reimbursement and high healthcare cost of revision surgery, minimizing additional healthcare expenditure is of interest. The purpose of this study is to provide an in-depth analysis of readmission rates after revision shoulder arthroplasty to potentially help reduce overall healthcare expenditure and improve systematic efficiency regarding patient care.

Methods

The Nationwide Readmissions Database was queried for revision shoulder arthroplasty procedures performed in the United States between 2016 and 2018 utilizing the ICD-10 Procedure Coding System. The national incidence was calculated, including patient demographics, comorbidities, facility characteristics, and overall rates and causes of both 30- and 90-day readmissions after revision shoulder arthroplasty procedure. The revision groups were then further subdivided into single component revisions and explantations.

Results

There were 31,289 revision shoulder arthroplasty cases estimated using weighted values. The average age of patients undergoing a revision procedure was 66.9, and of which 50.2% were females. The average length of stay was 2.9 days with total hospital charges averaging $82,314.76 per admission. Patients were more commonly discharged home vs. to a rehab facility (86.5% vs. 12.9%) and Medicare was the most common payer (67.9%). The average all-cause 30-day readmission rate was 3.09%. The average all-cause 90-day readmission rate was 3.58% when all-cause 30-day readmissions were excluded. For single component procedures, the most common surgical diagnosis for 30-day and 90-day readmissions was dislocation (5.56% and 2.48%, respectively). For explantation procedures, the most common surgical diagnosis for 30-day readmission was dislocation, followed by infection (1.49% vs. 0.90%, respectively). At 90 days, infection was the most common (1.04%). Cumulatively, the most common surgical diagnosis for readmission was dislocation followed by infection at both 30-days (1.81% and 0.9-%, respectively) and 90-days (1.09% and 1.02%, respectively). Atrial fibrillation followed by acute kidney failure was the most common medical diagnosis at both 30- (0.27% and 0.16%, respectively) and 90-day readmissions (0.17% and 0.12%, respectively).

Conclusions

Revision shoulder arthroplasty poses a cumulative risk of readmission within 30- and 90-days of 3.09% and 3.58%, respectively, with most readmissions occurring within the first 30 days. The most common overall diagnoses associated with readmission following a revision shoulder arthroplasty procedure were dislocation and infection with acute kidney failure being the most common medical diagnosis.