Background Data on the one-year postoperative revision, complication, and economic outcomes in a hospital setting after total shoulder arthroplasty (TSA) are sparse. Methods A retrospective cohort study using the Premier Healthcare Database, a hospital-billing data source, evaluated one-year postoperative revision, complication, and economic outcomes of reverse (RTSA) and anatomic (ATSA) TSA for patients who underwent the procedure from 2015 until 2021. All-cause revisits, including revision-related events (categorized as either irrigation and débridement or revision procedures and device removals) and shoulder/non-shoulder complications were collected. The incidences and costs of these revisits were evaluated. Generalized linear models were used to evaluate the associations between patient characteristics and revision and complication occurrences and costs. Results Among 51,478 RTSA and 34,623 ATSA patients (mean [standard deviation (SD)] ages RTSA 71.5 [8.1] years, ATSA 66.8 [9.0] years), one-year adjusted incidences of all-cause revisits, irrigation/débridement, revision procedures/device removals, and shoulder/non-shoulder complications were RTSA: 45.0% (95% confidence interval (CI): 44.6%-45.5%), 0.1% (95% CI: 0.1%-0.2%), 2.1% (95% CI: 2.0%-2.2%), and 17.8% (95% CI: 17.5%-18.1%) and ATSA: 42.3% (95% CI: 41.8%-42.9%), 0.2% (95% CI: 0.1%-0.2%), 1.9% (95% CI: 1.8%-2.1%), and 14.4% (95% CI: 14.0%-14.8%), respectively; shoulder-related complications were RTSA: 12.4% (95% CI: 12.1%-12.7%) and ATSA: 9.9% (95% CI: 9.6%-10.3%). Significant factors associated with a high risk of revisions and complications included, but were not limited to, chronic comorbidities and noncommercial insurance. Per patient, the mean (SD) total one-year hospital cost was $25,225 ($15,911) and $21,520 ($13,531) for RTSA and ATSA, respectively. Revision procedures and device removals were most costly, averaging $22,920 ($18,652) and $26,911 ($18,619) per procedure for RTSA and ATSA, respectively. Patients with revision-related events with infections had higher total hospital costs than patients without this event (RTSA: $60,887 (95% CI: $56,951-$64,823) and ATSA: $59,478 (95% CI: $52,312-$66,644)), equating to a mean difference of $36,148 with RTSA and $38,426 with ATSA. Significant factors associated with higher costs of revision-related events and complications included age, race, chronic comorbidities, and noncommercial insurance. Conclusions Nearly 45% RTSA and 42% ATSA patients returned to the hospital, most often for shoulder/non-shoulder complications (overall 17.8% RTSA and 14.4% ATSA, and shoulder-related 12.4% RTSA and 9.9% ATSA). Revisions and device removals were most expensive ($22,920 RTSA and $26,911 ATSA). Infection complications requiring revision had the highest one-year hospital costs (∼$60,000). This study highlights the need for technologies and surgical techniques that may help reduce TSA healthcare utilization and economic burden.

Total shoulder arthroplasty (TSA), while generally a successful procedure that improves shoulder function, can be associated with high post-operative resource utilization. Studies on hospital costs of post-operative care are sparse. The study objective was to estimate post-operative hospital costs after TSA and evaluate cost differences among patient characteristics.

Diabetic ketoacidosis (DKA) is a serious complication of diabetes, more common in T1DM than T2DM. Unmanaged DKA can be fatal and patients require emergency medical intervention. It is currently unclear how DKA impacts subpopulations of T1DM differently. This review investigated the burden and unmet need associated with DKA in pediatric/adolescent populations and in insulin-pump-users. Literature search via MEDLINE and Embase, using terms for unmet need and burden in T1DM, limited from 2011-21, plus conference proceedings search from last two years. Publications were screened using pre-specified PICOS criteria. 424 articles met the inclusion criteria;145 reported on pediatrics/adolescents and insulin-pump-users. Preliminary results show a high incidence of DKA with rates of up to 55.5 per 1,000 patient-years in T1DM patients overall, and 108 per 1,000 patient-years in pediatrics/adolescents. Readmission rate for DKA at six months was reported as 13.2% in pediatric patients; with high prevalence of DKA (up to 32%) in insulin-pump-users, often due to device malfunction. DKA was associated with higher HbA1c; mean values for DKA patients were 12.3±1.8% versus 10.9±2.5% with no DKA at diagnosis. Severity of DKA was associated with duration of hospital stay (No DKA: 12 days; Mild-moderate DKA: 13 days; severe DKA: 14 days, p<0.001); 22.4% of DKA-related hospitalizations were at diagnosis, with 20.4% admitted to intensive care and a readmission rate of 16.6%. Risk of DKA recurrence was higher in patients with a DKA episode in the previous year compared to those without (OR 9.0 95% CI 7.6-10.8). No literature reviews of this overall topic were identified. This was the first comprehensive review exploring the burden of DKA in pediatrics/adolescents and insulin-pump-users. These sub-populations were identified as high-risk for DKA, despite heterogeneity and inconsistency in reporting across studies. Further investigation into optimizing monitoring to reduce DKA is required.

Diabetic ketoacidosis (DKA) is a serious complication of diabetes, more common in T1DM than in T2DM. Unmanaged DKA requires emergency medical treatment and can be life-threatening. The review investigated the published economic burden of DKA focusing on pediatric/adolescent populations and insulin-pump-users.