Discharge Disposition Costs Following Total Shoulder Arthroplasty: A Comprehensive National Analysis

Abstract

Background Total shoulder arthroplasty (TSA) is the fastest growing sector of arthroplasty in the United States. One of the greatest drivers of costs following joint replacement surgery has been shown to be discharge disposition. This study examines the costs associated in the first 90 days of care following shoulder arthroplasty with a specific focus on the effects of discharge disposition. Methods We conducted a retrospective, case–control study of the entire Medicare population from 2011 to 2014 identifying TSA patients based on International Classification of Disease ninth revision codes. Only patients with demographic and discharge information were included. Costs were analyzed based on mean reimbursements. Patients were stratified according to 4 disposition groups: home, skilled nursing facility (SNF), intermediate care facility (ICF), and inpatient rehabilitation (InR). The correlation of the Charlson Comorbidity Index (CCI) to discharge disposition was also examined. Results A total of 50 979 patients met the inclusion criteria. The mean 90-day costs for patients discharged home were $12 691 (standard deviation [SD]: $471.9), for those who went to an SNF was $15 093 (SD: $622.4), for ICF $15 473 (SD: $2366) and for those who went to InR $24 731 (SD: $1922; P < .001). Over the 4-year period, trends in discharge to home significantly increased ( P = .037), while trends in discharge to InR significantly decreased ( P = .015). The CCI correlated significantly with discharge disposition setting ( P < .001). Conclusion The 90-day reimbursements of TSA are significantly affected by discharge disposition. Although discharge to home continues to increase, patients with a greater comorbidity burden are discharged more often to an inpatient facility.