Preparing for the bundled-payment initiative: the cost and clinical outcomes of total shoulder arthroplasty for the surgical treatment of glenohumeral arthritis at an average 4-year follow-up

Background: The purpose of this study is to report on cost, outcomes, reliability, and safety of total shoulder arthroplasty (TSA) in patients with symptomatic glenohumeral joint arthritis. Materials and methods: Eighty-three primary TSA patients operated on at a single institution by a single surgeon were prospectively studied for a mean of 48 months (range, 32-69 months). For each patient, validated subjective and independently evaluated objective outcome measures were collected to determine clinical reliability of TSA. In addition, safety-defined as the lack of major complications-and direct costs specific to each patient were collected and analyzed. Results: There were significant improvements (P < .01) in all clinical measures with the exception of the general health component of the Short Form 36 version 2. In addition, the majority of the patients met the criteria set forth for clinical reliability (76 of 83 [92%]) and safety (80 of 83 [96%]). The mean 4-year cost was $17,587, with the hospitalization accounting for 88% of this cost. Fiscal year was found to be responsible for the greatest fluctuation in total cost (P < .001). In addition, greater improvements in American Shoulder and Elbow Surgeons function scores (P = .022), higher preoperative social functioning scores on the Short Form 36 version 2 (P < .001), and female gender (P = .001) were correlated with lower cost. Conclusion: Before operative treatment, patients had moderate to severe shoulder pain and were limited in performing their activities. The mean 4-year cost of $17,587 allowed the purchase of treatment with TSA, leading to a greater than 5-fold reduction in pain and a nearly double improvement in shoulder function with a small risk of harm. (C) 2013 Journal of Shoulder and Elbow Surgery Board of Trustees.