Revision Thumb CMC Arthroplasty: Risk Factors and Healthcare Economic Implications.

Abstract

The risk factors as well as financial implications of revision thumb carpometacarpal joint(CMC) arthroplasty are unclear. We aimed to identify risk factors for revision thumb CMC surgery and how it impacts healthcare cost and utilization. We conducted a retrospective longitudinal analysis using a nationwide claims database, Optum's de-identified Clinformatics® Data Mart, between October 1st, 2015 and December 31st, 2018. Healthcare utilization and costs were measured from 1 year pre-operatively to 3 years post-operatively. Generalized linear mixed effect models with propensity score weighting were applied to evaluate the association between healthcare cost/utilization and revision surgery. Multivariable logistic regression was used to find associations between revision surgery and preoperative characteristics. 4,788(94.6%) patients underwent only primary CMC arthroplasty and 271(5.7%) patients underwent revision surgery. The revision group required $420(95%CI[275.74,564.77], p=0.01) and $3,878(95%CI[3732.50,4028.80]) more total healthcare costs on average compared to the primary surgery group at 1 and 2 years postoperatively. Similarly, the revision group required 20%(95%CI[1.09,1.31]) and 57%(95%CI[1.42,1.75]) more healthcare utilization on average compared to the primary group at 2 and 3 years postoperatively. The odds of revision increased by 51%(95%CI[1.04,1.98]) in patients younger than 55, and by 40% in patients with chronic pain diagnoses (95%CI[1.08,1.72]). Revision CMC arthroplasty patients required more yearly healthcare expenditure and utilization compared to patients undergoing primary CMC arthroplasty. Patients younger than 55 at the time of initial surgery and patients with chronic pain are more likely to undergo revision CMC arthroplasty; therefore, preoperative expectation management in these patients are crucial.Level of Evidence Level III.