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Big Data in Total Shoulder Arthroplasty

An In-depth Comparison of National Outcomes Databases

Lu, Yining BA; Khazi, Zain M. BS; Patel, Bhavik H. BA, BS; Agarwalla, Avinesh MD; Cancienne, Jourdan MD; Werner, Brian C. MD; Forsythe, Brian MD

Journal of the American Academy of Orthopaedic Surgeons: October 28, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.5435/JAAOS-D-19-00173
Research Article: PDF Only
SDC

Introduction: The practice of identifying trends in surgical decision-making through large-scale patient databases is commonplace. We hypothesize that notable differences exist between claims-based and prospectively collected clinical registries.

Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), a prospective surgical outcomes database, and PearlDiver (PD), a claims-based private insurance database, for patients undergoing primary total shoulder arthroplasties from 2007 to 2016. Comorbidities and 30-day complications were compared. Multiple regression analysis was performed for each cohort to identify notable contributors to 30-day revision surgery.

Results: Significant differences were observed in demographics, comorbidities, and postoperative complications for the age-matched groups between PD and NSQIP (P < 0.05 for all). Multiple regression analysis in PD identified morbid obesity and dyspnea to lead to an increased risk for revision surgery (P = 0.001) in the <65 cohort and dyspnea and diabetes to lead to an increased risk for revision surgery in the ≥65 cohort (P = 0.015, P < 0.001). Multiple regression did not reveal any risk factors for revision surgery in the <65 age group for the NSQIP; however, congestive heart failure was found to have an increased risk for revision surgery in the ≥65 cohort (P < 0.001).

Conclusions: Notable differences in comorbidities and complications for patients undergoing primary total shoulder arthroplasty were present between PD and NSQIP.

Level of Evidence: Retrospective cohort study, level III

From Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL (Mr. Lu, Mr. Patel, Dr. Agarwalla, Dr. Cancienne, and Dr. Forsythe), the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA (Mr. Khazi), and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Werner).

Correspondence to Dr. Forsythe: brian.forsythe@rushortho.com

None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Mr. Lu, Mr. Khazi, Mr. Patel, Dr. Agarwalla, Dr. Cancienne, Dr. Werner, and Dr. Forsythe.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Website (www.jaaos.org).

© 2019 by American Academy of Orthopaedic Surgeons
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