Expected Trends of Shoulder Arthroplasty Infection and Its Economic Burden in the United States

Abstract

Introduction: Periprosthetic joint infections (PJI) are a major cause of morbidity after shoulder arthroplasty. However, there is a paucity of the case trends and national economic impact they pose. In this study, we aimed to investigate the economic stress that shoulder PJIs place on the American healthcare system and the toll they will incur over the coming decade. Methods: The Nationwide Inpatient Sample (NIS) database was used to study trends in shoulder PJI cases and total hospital charges for anatomic total shoulder arthroplasty, reverse shoulder arthroplasty, and hemiarthroplasty from 2011 to 2018. A linear regression analysis was used to predict cases and total hospital charges through the year 2030. US dollar values were adjusted to 2021 relative purchasing power parity. Results: From 2011 to 2018, shoulder PJI procedure volumes increased by 226%. The rise PJI cases was demonstrated to outpace non-infected arthroplasties, rising from 0.8% in 2011 to 1.4% infection rate in 2018 The rise in cases translated to an increase in total charges, from $44.8 million in 2011 to $190.3 million in 2018. Linear regression modelling projects cases to rise by an additional 176% and annual charges to more than double to $459.6 million by 2030. Conclusion: This study demonstrates the large economic burden that shoulder PJIs pose on the American healthcare system, which is predicted to reach nearly half of a billion dollars in annual charges by 2030. Understanding trends in procedure volume and hospital charges will be critical in evaluating strategies to reduce shoulder PJIs.