title: Comorbidity effects on shoulder arthroplasty costs analysis of a nationwide private payer insurance data set.
abstract: BACKGROUND
  The purpose of this study was to evaluate the effect of common medical comorbidities on the reimbursements of different shoulder arthroplasty procedures.
  
  
  METHODS
  We conducted a retrospective query of a single private payer insurance claims database using PearlDiver (Warsaw, IN, USA) from 2010 to 2014. Our search included the Current Procedural Terminology codes and International Classification of Diseases, Ninth Revision codes for total shoulder arthroplasty (TSA), hemiarthroplasty, and reverse shoulder arthroplasty (RSA). Medical comorbidities were also searched for through International Classification of Diseases codes. The comorbidities selected for analysis were obesity, morbid obesity, hypertension, smoking, diabetes mellitus, hyperlipidemia, atrial fibrillation, chronic obstructive pulmonary disease, cirrhosis, depression, and chronic kidney disease (excluding end-stage renal disease). The reimbursement charges of the day of surgery, 90-day global period, and 90-day period excluding the initial surgical day of each comorbidity were analyzed and compared. Statistical analysis was conducted through analyses of variance or Kruskal-Wallis test.
  
  
  RESULTS
  Comorbidities did not have a significant effect on same-day reimbursements but instead caused a significant effect on the subsequent 89-day (interval) and 90-day reimbursements in the TSA and RSA cohorts. For TSA and RSA, the highest reimbursement costs during the 90-day period after surgery were seen with the diagnosis of hepatitis C, followed by atrial fibrillation and later chronic obstructive pulmonary disease. For hemiarthroplasty, the same was true in the following order: hepatitis C, cirrhosis, and atrial fibrillation.
  
  
  CONCLUSIONS
  Shoulder arthroplasty reimbursements are significantly affected by comorbidities at time intervals following the initial surgical day.
authors.affiliation: Orthopedic Research Institute, Holy Cross Hospital, Fort Lauderdale, FL, USA; Department of Orthopedics and Rehabilitation, University of Miami, Miami, FL, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Rosas
authors.affiliation: Department of Orthopedics and Rehabilitation, University of Miami, Miami, FL, USA.
authors.forename: Karim G
authors.initials: KG
authors.lastname: Sabeh
authors.affiliation: Department of Orthopedics and Rehabilitation, University of Miami, Miami, FL, USA.
authors.forename: Leonard T
authors.initials: LT
authors.lastname: Buller
authors.affiliation: Orthopedic Research Institute, Holy Cross Hospital, Fort Lauderdale, FL, USA.
authors.forename: Tsun Yee
authors.initials: TY
authors.lastname: Law
authors.affiliation: Department of Orthopedics and Rehabilitation, University of Miami, Miami, FL, USA.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Kalandiak
authors.affiliation: Orthopedic Research Institute, Holy Cross Hospital, Fort Lauderdale, FL, USA. Electronic address: Jonley123@yahoo.com.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Levy
mesh_terms: D000072228:Arthroplasty, Replacement, Shoulder / Q000191:economics*; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D062785:Hemiarthroplasty / Q000191:economics*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D008297:Male; D012189:Retrospective Studies
keywords: Shoulder arthroplasty; economic analysis; hemiarthroplasty; reverse; reverse shoulder arthroplasty; total