Introduction The reasons for referral and travel patterns are lacking for patients undergoing reverse shoulder arthroplasty (RSA). The purpose of this study was to compare comorbidities, surgical time, cost and complications between local and distant primary RSA patients. Methods Between 2007 and 2015, 1,666 primary RSAs were performed at our institution. Patients were divided into two cohorts, local patients (from within Olmstead county and surrounding counties, 492 RSAs) and those from a distance (1,174 RSAs). Results Local patients were older (74 vs 71 years, p < .001), more likely to have RSA for fracture, had a higher Charlson comorbidity score (3.8 vs 3.2, p < .001) and longer hospital stays (2.0 vs 1.8 days, p < 0.001) compared to referred patients. Referral patients required longer operative times (95 vs 88 min, p = .002), had higher hospitalization costs ($19,101 vs $18,735, p < .001), and had a higher rate of prior surgery (32 vs 24, p < .001). There were no differences between cohorts regarding complications or need for reoperation. Conclusions Patients traveling from a distance to undergo primary RSA had longer operative times and were more likely to have had prior surgery than local patients. This may demonstrate the referral bias seen at large academic centers and should be considered when reviewing RSA outcomes, hospital performance, and calculating insurance reimbursement.
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机译：引言 对于接受反向肩关节置换术 （RSA） 的患者，缺乏转诊和旅行模式的原因。本研究的目的是比较局部和远处原发性 RSA 患者的合并症、手术时间、成本和并发症。方法 2007 年至 2015 年间，我院进行了 1,666 例原发性 RSA。患者被分为两个队列，本地患者（来自奥姆斯特德县和周边县，492 个 RSA）和来自远方的患者（1,174 个 RSA）。结果 与转诊患者相比，本地患者年龄较大（74 vs 71岁，p < .001），骨折更有可能发生RSA，Charlson合并症评分更高（3.8 vs 3.2，p < .001），住院时间更长（2.0 vs 1.8天，p < 0.001）。转诊患者需要更长的手术时间（95 vs 88 min，p = .002），住院费用更高（$19,101 vs $18,735，p < .001），既往手术率更高（32% vs 24%，p < .001）。队列之间在并发症或再次手术需求方面没有差异。结论 远距离前行初次RSA的患者手术时间较长，且既往手术史较大。这可能表明在大型学术中心看到的转诊偏倚，在审查 RSA 结果、医院绩效和计算保险报销时应予以考虑。
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