title: Age-related differences in the use of total shoulder arthroplasty over time: use and outcomes.
abstract: We assessed the age-related differences in the use of total shoulder arthroplasty (TSA) and outcomes, and associated time-trends using the United States Nationwide Inpatient Sample (NIS) between 1998 and 2010. Age was categorised as < 50, 50 to 64, 65 to 79 and ≥ 80 years. Time-trends in the use of TSA were compared using logistic regression or the Cochran Armitage test. The overall use of TSA increased from 2.96/100 000 in 1998 to 12.68/100,000 in 2010. Significantly lower rates were noted between 2009 and 2010, compared with between 1998 and 2000, for: mortality, 0.1% versus 0.2% (p = 0.004); discharge to an inpatient facility, 13.3% versus 14.5% (p = 0.039), and hospital stay > median, 29.4% versus 51.2% (p < 0.001). The rates of use of TSA/100,000 by age groups, < 50, 50 to 64, 65 to 79 and ≥ 80 years were: 0.32, 4.62, 17.82 and 12.56, respectively in 1998 (p < 0.001); and 0.65, 17.49, 75.27 and 49.05, respectively in 2010 (p < 0.001) with an increasing age-related difference over time (p < 0.001). Across the age categories, there were significant differences in the proportion: discharged to an inpatient facility, 3.2% versus 4.2% versus 14.7% versus 36.5%, respectively in 1998 (p < 0.001) and 1.8% versus 4.3% versus 12.5% versus 35.5%, respectively in 2010 (p < 0.001) and the proportion with hospital stay > median, 39.7% versus 40.2% versus 53% versus 69%, respectively in 1998 (p < 0.001) and 17.2% versus 20.6% versus 28.7% versus 50.7%, respectively in 2010 (p < 0.001). In a nationally representative sample, we noted a time-related increase in the use of TSA and increasing age-related differences in outcomes indicating a changing epidemiology of the use of TSA. Age-related differences in outcomes suggest that attention should focus on groups with the worst outcomes.
authors.affiliation: University of Alabama at Birmingham, 510 20th Street South, FOT 805B, Birmingham, Alabama 35294, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Singh
authors.affiliation: University of Alabama at Birmingham, 510 20th Street South, FOT 805B, Birmingham, Alabama 35294, USA.
authors.forename: R
authors.initials: R
authors.lastname: Ramachandran
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012785:Shoulder Joint / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States
keywords: Age; discharge; elderly; hospital length of stay; mortality; outcomes; total shoulder arthroplasty; trends; use