title: 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.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Clinical Research Department, Foundation for Orthopaedic Research and Education, Tampa, FL, USA.
authors.forename: Nazeem A
authors.initials: NA
authors.lastname: Virani
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Williams
authors.forename: Rachel
authors.initials: R
authors.lastname: Clark
authors.forename: John
authors.initials: J
authors.lastname: Polikandriotis
authors.forename: Katheryne L
authors.initials: KL
authors.lastname: Downes
authors.forename: Mark A
authors.initials: MA
authors.lastname: Frankle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D015203:Reproducibility of Results; D012785:Shoulder Joint / Q000601:surgery*; D016896:Treatment Outcome
keywords: Case Series; Level IV; Total shoulder arthroplasty; Treatment Study; accountable care organizations; cost; glenohumeral arthritis; reliability; safety