title: Total shoulder arthroplasty for proximal humerus fracture is associated with increased hospital charges despite a shorter length of stay.
abstract: BACKGROUND
  Operation choice is a complex decision in the surgical management of proximal humerus fractures. Recently, there has been an increase in the use of total shoulder arthroplasty (TSA) for complex fracture patterns.
  
  
  OBJECTIVE
  Patients with proximal humerus fractures who receive TSA are more likely to have higher hospital charges and a prolonged length of stay relative to patients receiving hemiarthroplasty (HA), open reduction with internal fixation (ORIF) or closed reduction with internal fixation (CRIF).
  
  
  METHODS
  A statewide electronic database was used to identify 13,316 hospital admissions from 2000-2011 were a proximal humerus fracture was surgically managed in an effort to determine the effect of operation choice on cost and length of stay. A univariate analysis was preformed to examine overall trends in surgical management. Additionally, a periodic, multivariate logistic regression analysis was used to determine how operation choice affected the odds of a high cost hospital stay or a prolonged length of stay after controlling for age, comorbidity burden, gender, and insurance type.
  
  
  RESULTS
  After controlling for confounding factors, patients receiving total shoulder arthroplasty (TSA) were 2.25 times more likely to have high total hospital charges than patients receiving HA and 3.21 times more likely than patients receiving ORIF. Additionally, TSA was found to be a significant negative predictor of prolonged length of stay (pLOS). HA, ORIF and CRIF did not significantly predict pLOS.
  
  
  CONCLUSIONS
  The use of TSA for acute proximal humerus fractures is associated with increased hospital costs despite a shorter length of stay when compared to other operative choices. As reverse total shoulder arthroplasty becomes more popular for treatment of this injury, it is important that functional outcomes be interpreted in the context of relative cost trade-offs.
  
  
  METHODS
  Level IV.
authors.affiliation: NYU hospital for joint diseases, New York, United States.
authors.forename: A
authors.initials: A
authors.lastname: Manoli
authors.affiliation: NYU hospital for joint diseases, New York, United States.
authors.forename: C E
authors.initials: CE
authors.lastname: Capriccioso
authors.affiliation: NYU hospital for joint diseases, New York, United States.
authors.forename: S R
authors.initials: SR
authors.lastname: Konda
authors.affiliation: NYU hospital for joint diseases, New York, United States. Electronic address: kenneth.egol@nyumc.org.
authors.forename: K A
authors.initials: KA
authors.lastname: Egol
mesh_terms: D000368:Aged; D019643:Arthroplasty, Replacement / Q000191:economics*; D005260:Female; D005593:Fracture Fixation, Internal / Q000191:economics*; D017722:Hospital Charges / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000191:economics* / Q000639:trends; D008297:Male; D008875:Middle Aged; D012784:Shoulder Fractures / Q000191:economics / Q000601:surgery*; D012785:Shoulder Joint / Q000601:surgery*
keywords: Cost; Hemiarthroplasty; Length of stay; Proximal humerus fracture; Total shoulder arthroplasty