Ambulatory shoulder arthroplasty provides a mild reduction in overall cost compared with inpatient shoulder arthroplasty cost of ambulatory shoulder arthroplasty

• Published in: Journal of shoulder and elbow surgery Vol. 31; no. 6; pp. S90 - S93
• Main Authors: Cronin, Kevin J., Lazarus, Mark D., Ramsey, Matthew L., Namdari, Surena
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2022
• Subjects: ambulatory surgery center; cost analysis; cost-effectiveness; outpatient shoulder arthroplasty; reverse shoulder arthroplasty; Total shoulder arthroplasty; outpatient shoulder arthroplasty; cost-effectiveness; Level IV; reverse shoulder arthroplasty; ambulatory surgery center; Total shoulder arthroplasty; cost analysis; Economic Study
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2021.10.038

The purpose of this study was to determine the relative cost difference of inpatient vs. ambulatory total shoulder arthroplasty (TSA) procedures.
A retrospective case series was performed to identify a consecutive series of patients who underwent primary anatomic or reverse TSA at 2 orthopedic specialty hospitals between September 2015 and August 2020. Those undergoing surgery for fracture or revision were excluded. Itemized facility costs were analyzed with a time-driven activity-based costing model and compared between ambulatory and non-ambulatory procedures. Ambulatory patients were defined as those admitted and discharged on the same calendar day. All other patients were considered non-ambulatory.
A total of 1027 patients were analyzed, comprising 38 ambulatory patients (3.7%) and 989 non-ambulatory patients (96.3%). There was a higher proportion of anatomic TSA than reverse shoulder arthroplasty in the ambulatory group (81.6% vs. 51.7%, P < .0001). Overall, there was no difference in cost between the 2 groups ($8832 vs. $8841, P = .97). However, personnel costs were greater in the non–same-day group ($1895 vs. $2743, P < .0001) whereas supply costs were less ($6937 vs. $6097, P < .0003). When implant costs were excluded, outpatient shoulder arthroplasty provided a cost savings of $745.
Ambulatory shoulder arthroplasty provides a mild cost savings of $745 after controlling for fixed costs. This is much less dramatic than previously reported and should raise concern as shoulder arthroplasty continues to be targeted by payers as a potential for cost savings through decreased reimbursement.