Relationship between hospital size and teaching status on outcomes for reverse shoulder arthroplasty

  • V. J. SabesanEmail author
  • J. D. Whaley
  • M. LaVelle
  • G. Petersen-Fitts
  • D. Lombardo
  • D. Yong
  • D. Malone
  • J. Khan
  • D. J. L. Lima
Original Article



The use of reverse shoulder arthroplasty (RSA) continues to grow with expanding indications and increased surgeon awareness. Previous data for other lower extremity joint replacements indicate that high-volume centers have better outcomes, with lower complication rates, decreased length of stay, and complications for both hemiarthroplasty and total shoulder arthroplasty. The purpose of this study is to evaluate the effects of hospital size and setting on adverse events for RSA.

Materials and methods

The National Inpatient Sample database was queried for RSA performed using ICD-9 codes. Primary outcomes included length of stay (LOS), total hospital charges, discharge disposition, and postoperative complications. Odds ratios were used to assess the risk of inpatient postoperative complications.


A weighted national estimate of 24,056 discharges for patients undergoing RSA was included in the study. Patients at larger hospitals experienced higher total charges, increased average LOS, and slightly higher complication rates compared to those of small and medium hospitals. Patients in larger hospitals had significantly increased rates of genitourinary and central nervous system complications, while patients in small/medium hospitals experienced higher rates of hematoma/seroma.


Results from this study indicate that large and non-teaching hospitals overall tend to burden the patients with higher hospital charges, longer hospital stay, and more frequent non-routine discharges. Also, larger hospitals are associated with higher risk of genitourinary and central nervous system complications rates, whereas non-teaching hospitals are associated with lower risk of infection and higher risk of anemia after RSA. With the growth in RSA in the USA, continued attention needs to be placed on improving outcomes and resource utilization for RSA patients even in larger hospitals.


Reverse total shoulder arthroplasty National inpatient sample Adverse events Resource utilization 


Compliance with ethical standards

Conflict of interest

Vani Sabesan is a paid consultant for Arthrex Inc, receives Research Support from Exactech Inc and Pacira Pharmaceuticals, and was a recipient of an Orthopaedic Research and Education Foundation grant. All other authors, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.

Human and animal rights

This article does not contain any studies with human participants or animals performed by the authors.


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Copyright information

© Istituto Ortopedico Rizzoli 2019

Authors and Affiliations

  • V. J. Sabesan
    • 1
    Email author
  • J. D. Whaley
    • 2
  • M. LaVelle
    • 2
  • G. Petersen-Fitts
    • 3
  • D. Lombardo
    • 3
  • D. Yong
    • 2
  • D. Malone
    • 1
  • J. Khan
    • 3
  • D. J. L. Lima
    • 1
  1. 1.Department of Orthopaedic SurgeryCleveland Clinic FloridaWestonUSA
  2. 2.Department of Orthopaedic SurgeryWayne State University School of MedicineTaylorUSA
  3. 3.Department of Orthopaedic SurgeryBeaumont HealthTaylorUSA

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