1
|
Flurin PH, Abadie P, Lavignac P, Laumonerie P, Throckmorton TW. Outpatient vs. inpatient total shoulder arthroplasty: complication rates, clinical outcomes, and eligibility parameters. JSES Int 2024; 8:483-490. [PMID: 38707575 PMCID: PMC11064623 DOI: 10.1016/j.jseint.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Background Improvements in total shoulder arthroplasty (TSA), fast-track surgery, multimodal anesthesia, and rehabilitation protocols have opened up the possibility of outpatient care that is now routinely practiced at our European institution. The first objective of this study was to define the TSA outpatient population and to verify that outpatient management of TSA does not increase the risk of complications. The second objective was to determine patient eligibility parameters and the third was to compare functional outcomes and identify influencing factors. Methods The study included 165 patients who had primary TSA (106 outpatient and 59 inpatient procedures). The operative technique was the same for both groups. Demographics, complications, readmissions, and revisions were collected. American Society of Anesthesiologists, Constant, American Shoulder and Elbow Surgeons, University of California Los Angeles shoulder, and Shoulder Pain and Disability Index scores were obtained preoperatively and at 1.5, 6, and 12 months postoperatively. Satisfaction and visual analog scale pain scores also were documented. Statistical analysis was completed using multivariate linear regression. Results Outpatients were significantly younger and had lower American Society of Anesthesiologists scores than inpatients. The rates of complications, readmissions, and reoperations were not significantly different between groups. Outpatient surgery was not an independent risk factor for complications. At 1.5 months, better outcomes were noted in the outpatient group for all scores, and these reached statistical significance. Distance to home, dominant side, operative time, and blood loss were not associated with functional results. Multivariate analysis demonstrated that outpatient care was significantly associated with improved scores at 1.5 months and did not affect functional outcomes at 6 and 12 months. Conclusion This study reports the results of routine outpatient TSA within a European healthcare system. TSA performed in an outpatient setting was not an independent risk factor for complications and seemed to be an independent factor in improving early functional results.
Collapse
Affiliation(s)
| | | | | | | | - Thomas W. Throckmorton
- Department of Orthopaedic Surgery, Univeristy of Tennessee-Campbell Clinic, Memphis, TN, USA
| |
Collapse
|
2
|
Posner AD, Kuna MC, Carroll JD, Perloff EM, Anderson MJ, Hutchinson ID, Zimmerman JP. Anatomic total shoulder arthroplasty with a nonspherical humeral head and inlay glenoid: 90-day complication profile in the inpatient versus outpatient setting. Clin Shoulder Elb 2023; 26:380-389. [PMID: 37957884 DOI: 10.5397/cise.2023.00479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/19/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) with a nonspherical humeral head component and inlay glenoid is a successful bone-preserving treatment for glenohumeral arthritis. This study aimed to describe the 90-day complication profile of TSA with this prosthesis and compare major and minor complication and readmission rates between inpatient- and outpatient-procedure patients. METHODS A retrospective review was performed of a consecutive cohort of patients undergoing TSA with a nonspherical humeral head and inlay glenoid in the inpatient and outpatient settings by a single surgeon between 2017 and 2022. Age, sex, body mass index, American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), and 90-day complication and readmission rates were compared between inpatient and outpatient groups. RESULTS One hundred eighteen TSAs in 111 patients were identified. Mean age was 64.9 years (range, 39-90) and 65% of patients were male. Ninety-four (80%) and 24 (20%) patients underwent outpatient and inpatient procedures, respectively. Four complications (3.4%) were recorded: axillary nerve stretch injury, isolated ipsilateral arm deep venous thrombosis (DVT), ipsilateral arm DVT with pulmonary embolism requiring readmission, and gastrointestinal bleed requiring readmission. There were no reoperations or other complications. Outpatients were younger with lower ASA and CCI scores than inpatients; however, there was no difference in complications (1/24 vs. 3/94, P=1.00) or readmissions (1/24 vs. 1/94, P=0.37) between these two groups. CONCLUSIONS TSA with a nonspherical humeral head and inlay glenoid can be performed safely in both inpatient and outpatient settings. Rates of early complications and readmissions were low with no difference according to surgical setting. Level of evidence: IV.
Collapse
Affiliation(s)
- Andrew D Posner
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Michael C Kuna
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Jeremy D Carroll
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Eric M Perloff
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Matthew J Anderson
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Ian D Hutchinson
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Joseph P Zimmerman
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| |
Collapse
|
3
|
Kim M, Ling K, Tantone RP, Al-Humadi S, Wang K, VanHelmond TA, Komatsu DE, Wang ED. Investigating immediate postoperative medical complication risks relative to in-hospital length of stay after total shoulder arthroplasty. JSES Int 2023; 7:2467-2472. [PMID: 37969519 PMCID: PMC10638588 DOI: 10.1016/j.jseint.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background The purpose of this study was to investigate the association between in-hospital length of stay (LOS) and postoperative complication rates within 30 days of total shoulder arthroplasty (TSA). Methods All patients who underwent either anatomic or reverse TSA between 2015 and 2019 were queried from the American College of Surgeons National Surgical Quality Improvement database. The study population was stratified into three cohorts as follows: LOS 0 (same-day discharge), LOS 1 (next-day discharge), and LOS 2-3 (LOS of 2-3 days). Patient demographics and comorbidities were compared between cohorts using bivariate analysis. Multivariate logistic regression analysis was conducted to investigate the relationship between LOS and postoperative complications. Results In comparison to the LOS 0 day cohort, LOS 2-3 day cohort had a greater likelihood of developing overall complication (OR, 2.598; P < .001), major complication (OR, 1.885; P < .001), minor complication (OR: 3.939; P < .001), respiratory complication (OR: 12.979; P = .011), postoperative anemia requiring transfusion (OR, 23.338; P < .001), non-home discharge (OR, 10.430; P < .001), and hospital readmission (OR, 1.700; P = .012). Similarly, in comparison to the LOS 1 cohort, LOS 2-3 cohort had a greater likelihood of developing overall complication (OR: 2.111; P < .001), major complication (OR, 1.423; P < .001), minor complication (OR, 3.626; P < .001), respiratory complication (OR, 2.057; P < .001), sepsis or septic shock (OR: 2.795; P = .008), urinary tract infection (OR, 1.524; P = .031), postoperative anemia requiring transfusion (OR, 10.792; P < .001), non-home discharge (OR: 10.179; P < .001), hospital readmission (OR, 1.395; P < .001), and return to the operating room (OR. 1.394; P = .014). There was no significant difference in the risk of developing postoperative complications between LOS 0 day and LOS 1 day cohort. On baseline, the LOS 1 and LOS 2-3 day cohort had a higher proportion of patients with the following demographics and comorbidities compared to LOS 0 day cohort: advanced age, higher body mass index, female gender, positive smoking status, insulin-dependent diabetes, noninsulin-dependent diabetes, dyspnea at rest and moderate exertion, partially dependent functional status, an American Society of Anesthesiologists classification of 3 or higher, a history of severe chronic obstructive pulmonary disease, a history of congestive heart failure, the use of hypertension medication, disseminated cancer, wound infection, the use of steroids, and a history of bleeding disorder. Conclusion Patients who were discharged on the same and next day following TSA demonstrated a reduced probability of experiencing respiratory complications, infections, postoperative anemia requiring transfusion, non-home discharge, and readmission in comparison to those with a LOS of 2-3 days. There was no difference in postoperative complications between same and nextday discharged patients. Patients who underwent outpatient arthroplasty were healthier at baseline compared to those who underwent inpatient arthroplasty.
Collapse
Affiliation(s)
- Matthew Kim
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Kenny Ling
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Ryan P. Tantone
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Samer Al-Humadi
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Katherine Wang
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Taylor A. VanHelmond
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - David E. Komatsu
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Edward D. Wang
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| |
Collapse
|
4
|
Piantoni L, Tello CA, Remondino RG, Galaretto E, Noel MA. Protocolo multimodal farmacológico perioperatorio para la cirugía de columna en pediatría. REVISTA DE LA ASOCIACIÓN ARGENTINA DE ORTOPEDIA Y TRAUMATOLOGÍA 2022. [DOI: 10.15417/issn.1852-7434.2022.87.6.1490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Introducción: La cirugía de columna es uno de los procedimientos con mayor morbimortalidad dentro de la población pediátrica; el manejo farmacológico del dolor en dicha población aún no se encuentra estandarizado. La analgesia multimodal trata de responder a esta problemática.
Objetivo: Sobre la base de una revisión sistemática de la bibliografía, desarrollar un detallado protocolomultimodal farmacológico para el manejo del dolor pre- y posoperatorio intra/extrahospitalario para la cirugía de columna en niños.
Materiales y Métodos: Se realizó una revisión sistemática de textos completos en inglés o español en PubMed, Embase, Cochrane Library y LILACS Database publicados entre 2000 y 2021; se aplicó el diagrama de flujo PRISMA.
Resultados: De 756 artículos preseleccionados, 38 fueron incluidos en la evaluación final. Dada la dificultad bioética de desarrollar trabajos en formato de ensayos clínicos con fármacos y combinaciones de ellos en la población pediátrica, desarrollamos un protocolo detallado de manejo del dolor pre- y posoperatorio por vía intravenosa/oral, intra- y extrahospitalario, para aplicar en niños sometidos a cirugía de columna.
Conclusión: Logramos desarrollar un detallado protocolo multimodal farmacológico para el perioperatorio intra- y extrahospitalario de cirugía de columna en niños, sencillo y reproducible, tendiente a acelerar la recuperación funcional del paciente y disminuir los costos socioeconómicos globales.Nivel de Evidencia: II
Collapse
|
5
|
Reddy RP, Sabzevari S, Charles S, Singh-Varma A, Como M, Lin A. Outpatient shoulder arthroplasty in the COVID-19 era: 90-day complications and risk factors. J Shoulder Elbow Surg 2022; 32:1043-1050. [PMID: 36470518 PMCID: PMC9719845 DOI: 10.1016/j.jse.2022.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND With the COVID-19 pandemic placing an increased burden on health care systems, shoulder arthroplasties are more commonly being performed as outpatient procedures. The purpose of this study was to characterize the 90-day episode-of-care complications of consecutive shoulder arthroplasties defaulted for outpatient surgery without using a prior algorithm for patient selection and to assess for their risk factors. We hypothesized that outpatient shoulder arthroplasty would be a safe procedure for all patients, regardless of patient demographics and comorbidities. METHODS A retrospective review of consecutive patients who underwent planned outpatient anatomic or reverse total shoulder arthroplasty between March 2020 and January 2022 with 3-month follow-up was performed. All patients were scheduled for outpatient surgery regardless of medical comorbidities. Patient demographics; pre/postoperative patient-reported outcomes including visual analog scale, subjective shoulder value, and American Shoulder and Elbow Surgeons score; pre/postoperative range of motion; and complications were collected from medical chart review. Multivariate logistic regression was used to identify predictors of the following outcomes: 1. Unplanned overnight hospital stay, 2. 90-day unplanned emergency department (ED)/clinic visit, 3. 90-day hospital readmission, 4. 90-day complications requiring revision. RESULTS One hundred twenty-seven patients (47% male, 17% tobacco users, 18% diabetics) with a mean age 69 ± 9 years were identified, of whom 92 underwent reverse total shoulder arthroplasty and 35 underwent anatomic total shoulder arthroplasty. All patient-reported outcomes and range of motion were significantly improved at 3 months. There were 15 unplanned overnight hospital stays (11.8%) after the procedure. Within 90 days postoperatively, there were 17 unplanned ED/clinic visits (13.4%), 7 hospital readmissions (5.5%), and 4 complications requiring revision (3.1%). Factors predictive of unplanned overnight stay included age above 70 years (odds ratio [OR], 36.80 [95% confidence interval [CI], 2.20-615.49]; P = .012), tobacco use (OR, 12.90 [95% CI, 1.23-135.31]; P = .033), and American Society of Anesthesiologists status of 3 (OR, 13.84 [95% CI, 1.22-156.57]; P = .034). The only factor predictive of unplanned ED/clinic visit was age over 70 years old (OR, 7.52 [95% CI, 1.26-45.45]; P = .027). No factors were predictive of 90-day hospital readmission or revision. CONCLUSION Outpatient shoulder arthroplasty is a safe procedure with excellent outcomes and low rates of readmissions and can be considered as the default plan for all patient undergoing shoulder arthroplasty. Patients who are above 70 years of age, use tobacco, and have ASA score of 3, however, may be less suitable for outpatient arthroplasty and should be counseled regarding the higher risk of unplanned overnight hospitalization.
Collapse
Affiliation(s)
- Rajiv P Reddy
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Soheil Sabzevari
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Shaquille Charles
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Anya Singh-Varma
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Matthew Como
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Albert Lin
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA.
| |
Collapse
|
6
|
Allahabadi S, Cheung EC, Hodax JD, Feeley BT, Ma CB, Lansdown DA. Outpatient Shoulder Arthroplasty-A Systematic Review. J Shoulder Elb Arthroplast 2022; 5:24715492211028025. [PMID: 34993380 PMCID: PMC8492032 DOI: 10.1177/24715492211028025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/07/2021] [Indexed: 11/15/2022] Open
Abstract
Objective Recent reports have shown that outpatient shoulder arthroplasty (SA) may be a safe alternative to inpatient management in appropriately selected patients. The purpose was to review the literature reporting on outpatient SA. Methods A systematic review of publications on outpatient SA was performed. Included publications discussed patients who were discharged on the same calendar day or within 23 hours from surgery. Articles were categorized by discussions on complications, readmissions, and safety, patient selection, pain management strategies, cost effectiveness, and patient and surgeon satisfaction. Results Twenty-six articles were included. Patients undergoing outpatient SA were younger and with a lower BMI than those undergoing inpatient SA. Larger database studies reported more medical complications for patients undergoing inpatient compared to outpatient SA. Articles on pain management strategies discussed both single shot and continuous interscalene blocks with similar outcomes. Both patients and surgeons reported high levels of satisfaction following outpatient SA, and cost analysis studies demonstrated significant cost savings for outpatient SA. Conclusion In appropriately selected patients, outpatient SA can be a safe, cost-saving alternative to inpatient care and may lead to high satisfaction of both patients and physicians, though further studies are needed to clarify appropriate utilization of outpatient SA.
Collapse
Affiliation(s)
- Sachin Allahabadi
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Edward C Cheung
- Department of Orthopaedic Surgery, University of California, Los Angeles, California
| | - Jonathan D Hodax
- Department of Orthopaedic Surgery, Virginia Mason Medical Center, Virginia Mason Medical Center, Seattle, Washington
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Chunbong B Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| |
Collapse
|
7
|
Malahias MA, Kokkineli S, Gu A, Karanikas D, Kaar SG, Antonogiannakis E. Day case versus inpatient total shoulder arthroplasty: A systematic review and meta-analysis. Shoulder Elbow 2021; 13:471-481. [PMID: 34659480 PMCID: PMC8512977 DOI: 10.1177/1758573220944411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND A number of papers have been published comparing the safety and efficacy of day case and inpatient anatomic or reverse total shoulder arthroplasty. However, no systematic review of the literature has been published to date. The aim of this review was to determine if day case total shoulder arthroplasty (length of stay <24 h) leads to similar outcomes as standard-stay inpatients (length of stay ≥24 h). METHODS The US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviewers were queried for publications utilizing keywords that were pertinent to total shoulder arthroplasty, day case, outpatient and inpatient, clinical or functional outcomes, and complications. In order to determine the quantitative impact of day case total shoulder arthroplasty on readmission and revision rate, a meta-analysis was performed on articles that observed 30- or 90-day readmission or revision. RESULTS Eight articles were found to be suitable for inclusion in the present study which included 6103 day case total shoulder arthroplasty and 147,463 inpatient total shoulder arthroplasty. Following meta-analysis, there was no significant difference among patients who underwent day case total shoulder arthroplasty compared to inpatient total shoulder arthroplasty regarding revision rates (OR: 1.001; 95% CI: 0.721-1.389; p = 0.995) and 30-day readmission rates (OR: 0.940; 95% CI: 0.723-1.223; p = 0.646). In contrast, patients who underwent day case total shoulder arthroplasty were less likely to have a readmission within 90 days compared to their inpatient counterparts (OR: 0.839; 95% CI: 0.704-0.999; p = 0.049). Two out of eight studies reported comparable baseline clinical characteristics among groups, while five studies reported significant differences and one study did not provide information regarding clinical characteristics, such as medical comorbidities or American Society of Anaesthesiologists'(ASA) score. No significant difference among groups was found in all or almost all studies regarding mortality rates, and rates of cardiac complications, cerebrovascular events, thromboembolic events, pulmonary complications, cardiac complications, and nerve complications. Finally, results were rather conflicting regarding the correlation of day case total shoulder arthroplasty to the rate of surgical site infections. CONCLUSIONS This study showed that day case total shoulder arthroplasty might lead to similar rates of mortality, complications, revisions, and readmissions compared to inpatient total shoulder arthroplasty when used in a selected population of younger, healthier, and more male patients. In contrast, there was no consensus regarding the impact of day case total shoulder arthroplasty on the rate of surgical site infections. Finally, further research of higher quality is required to establish patient demographic criteria, ASA score, or comorbidity index cut off that might be used to define day case-treated patients who seem to have equivalent outcomes compared to inpatient-treated patients.Level of evidence: Systematic review of level III studies (lowest level included).
Collapse
Affiliation(s)
- Michael-Alexander Malahias
- The Stavros Niarchos Foundation Complex
Joint Reconstruction Center,
Hospital
for Special Surgery, New York, USA,3rd Orthopaedic Department, HYGEIA
Hospital, Athens, Greece
| | | | - Alex Gu
- The Stavros Niarchos Foundation Complex
Joint Reconstruction Center,
Hospital
for Special Surgery, New York, USA
| | - Dimitris Karanikas
- 2nd Orthopaedic Department, School of
Medicine, National and Kapodistrian University of Athens, Athens, Greece,Dimitris Karanikas, 2nd Orthopaedic
Department, School of Medicine, National and Kapodistrian University of Athens,
Athens, Greece.
| | - Scott G Kaar
- Sports Medicine and Shoulder Surgery,
Department of Orthopaedic Surgery, St Louis University, St Louis, USA
| | | |
Collapse
|
8
|
Thangarajah T. Day case shoulder arthroplasty: needed now more than ever. Br J Hosp Med (Lond) 2021; 82:1-7. [PMID: 34431350 DOI: 10.12968/hmed.2021.0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The demand for total shoulder arthroplasty has grown over the years and is set to continue in a similar trend because of the ageing population. Following a global reduction in elective orthopaedic treatment and an exponential rise in surgical waiting times, innovative strategies are desperately needed to mitigate against the harmful effects of delaying vital operations on both patients and the wider society. Day case shoulder arthroplasty is a safe alternative to a traditional inpatient approach, with evidence supporting substantial cost savings, improved outcomes and fewer complications. Rigorous patient selection and a multidisciplinary team approach are paramount when adopting a day case service to deliver joint replacement surgery. This review outlines the principles of day case total shoulder arthroplasty and highlights key considerations when transitioning to this approach.
Collapse
Affiliation(s)
- Tanujan Thangarajah
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
9
|
Polisetty TS, Grewal G, Drawbert H, Ardeljan A, Colley R, Levy JC. Determining the validity of the Outpatient Arthroplasty Risk Assessment (OARA) tool for identifying patients for safe same-day discharge after primary shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:1794-1802. [PMID: 33290852 DOI: 10.1016/j.jse.2020.10.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/21/2020] [Accepted: 10/30/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Early discharge has been a target of cost-control efforts given the growing demand for joint replacement surgery. The Outpatient Arthroplasty Risk Assessment (OARA) score, a medically based risk-assessment score, has shown high predictive ability in achieving safe early discharge following outpatient lower-extremity arthroplasty using a score threshold initially set at ≤59 points but more recently adapted to ≤79 points. However, no study has been performed using the OARA tool for shoulder replacement, which has been shown to have lower associated medical risks than lower-extremity arthroplasty. The purpose of this study was to determine the OARA score threshold for same-day discharge (SDD) following shoulder arthroplasty and evaluate its effectiveness in selecting patients for SDD. We hypothesized that the OARA score threshold for shoulder arthroplasty would be higher than that for lower-extremity arthroplasty. METHODS We performed a retrospective review of 422 patients who underwent primary anatomic or reverse shoulder arthroplasty between April 2018 and October 2019 performed by a single surgeon. As standard practice, all patients were counseled preoperatively regarding SDD and given the choice to stay overnight. Medical history, length of stay, and 90-day readmissions were obtained from medical records. Analysis of variance testing and screening test characteristics compared the performance of the OARA score vs. the American Society of Anesthesiologists Physical Status (ASA-PS) class and a previously published OARA score threshold used to define a low risk of outpatient lower-extremity arthroplasty. RESULTS A preoperative OARA score cutoff of ≤110 points demonstrated a sensitivity of 98.0% for identifying patients with SDD after shoulder arthroplasty, compared with 66.7% using the hip and knee OARA score threshold of ≤59 points (P < .0001) and 80.4% using ASA-PS class ≤ 2 (P = .008). OARA scores ≤ 110 points also showed a negative predictive value of 98.9% and a false-negative rate of 2.0% but remained incomprehensive with a specificity of 24.0% (P < .0001). Analysis of variance demonstrated that mean OARA scores increased significantly with length of stay (P = .001) compared with ASA-PS classes (P = .82). Patients with OARA scores ≤ 110 points were also 2.5 times less likely to have 90-day emergency department visits (P = .04) than those with OARA scores > 110 points. There was no difference in 30- and 90-day readmission rates for patients with OARA scores ≤ 59 points, OARA scores ≤ 110 points, and ASA-PS classes ≤ 2. CONCLUSION Our study suggests that a preoperative OARA score threshold of ≤110 points is effective and conservative in screening patients for SDD following shoulder arthroplasty, with low rates of 90-day emergency department visits and readmissions. This threshold is a useful screening tool to identify patients who are not good candidates for SDD.
Collapse
Affiliation(s)
| | - Gagan Grewal
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA
| | - Hans Drawbert
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Andrew Ardeljan
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Ryan Colley
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA
| | | |
Collapse
|
10
|
Huddleston HP, Mehta N, Polce EM, Williams BT, Fu MC, Yanke AB, Verma NN. Complication rates and outcomes after outpatient shoulder arthroplasty: a systematic review. JSES Int 2021; 5:413-423. [PMID: 34136848 PMCID: PMC8178605 DOI: 10.1016/j.jseint.2020.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background As the number of total shoulder arthroplasties (TSAs) performed annually increases, some surgeons have begun to shift toward performing TSAs in the outpatient setting. However, it is imperative to establish the safety of outpatient TSA. The purpose of this systematic review was to define complication, readmission, and reoperation rates and patient-reported outcomes after outpatient TSA. Methods A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using three databases (PubMed, Ovid, and Embase). English-language publications describing results on complication rates in patients who underwent TSA in an outpatient or ambulatory setting were included. All nonclinical and deidentified database studies were excluded. Bias assessment was conducted with the methodologic index for nonrandomized studies criteria. Results Seven studies describing outcomes in outpatient TSA were identified for inclusion. The included studies used varying criteria for selecting patients for an outpatient procedure. The total outpatient 90-day complication rate (commonly including hematomas, wound issues, and nerve palsies) ranged from 7.1%-11.5%. Readmission rates ranged from 0%-3.7%, and emergency and urgent care visits ranged from 2.4%-16.1%. Patient-reported outcomes improved significantly after outpatient TSA in all studies. Two studies found a higher complication rate in the comparative inpatient cohort (P = .023-.027). Methodologic index for nonrandomized studies scores ranged from 9 to 11 (of 16) for noncomparative studies (n = 3), while all comparative studies received a score of a 16 (of 24). Conclusion Outpatient TSA in properly selected patients results in a similar complication rate to inpatient TSA. Further studies are needed to aid in determining proper risk stratification to direct patients to inpatient or outpatient shoulder arthroplasty.
Collapse
Affiliation(s)
| | - Nabil Mehta
- Rush University Medical Center, Chicago, IL, USA
| | - Evan M Polce
- Rush University Medical Center, Chicago, IL, USA
| | | | - Michael C Fu
- Rush University Medical Center, Chicago, IL, USA
| | - Adam B Yanke
- Rush University Medical Center, Chicago, IL, USA
| | | |
Collapse
|
11
|
Dillon MT, Chan PH, Prentice HA, Royse KE, Paxton EW, Okike K, Khatod M, Navarro RA. The effect of a statewide COVID-19 shelter-in-place order on shoulder arthroplasty for proximal humerus fracture volume and length of stay. ACTA ACUST UNITED AC 2021; 31:339-345. [PMID: 34334985 PMCID: PMC7923956 DOI: 10.1053/j.sart.2021.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Although the COVID-19 pandemic has disrupted elective shoulder arthroplasty throughput, traumatic shoulder arthroplasty procedures are less apt to be postponed. We sought to evaluate shoulder arthroplasty utilization for fracture during the COVID-19 pandemic and California's associated shelter-in-place order compared to historical controls. Methods We conducted a cohort study with historical controls, identifying patients who underwent shoulder arthroplasty for proximal humerus fracture in California using our integrated electronic health record. The time period of interest was following the implementation of the statewide shelter-in-place order: March 19, 2020-May 31, 2020. This was compared to three historical periods: January 1, 2020-March 18, 2020, March 18, 2019-May 31, 2019, and January 1, 2019-March 18, 2019. Procedure volume, patient characteristics, in-hospital length of stay, and 30-day events (emergency department visit, readmission, infection, pneumonia, and death) were reported. Changes over time were analyzed using linear regression adjusted for usual seasonal and yearly changes and age, sex, comorbidities, and postadmission factors. Results Surgical volume dropped from an average of 4.4, 5.2, and 2.6 surgeries per week in the historical time periods, respectively, to 2.4 surgeries per week after shelter-in-place. While no more than 30% of all shoulder arthroplasty procedures performed during any given week were for fracture during the historical time periods, arthroplasties performed for fracture was the overwhelming primary indication immediately after the shelter-in-place order. More patients were discharged the day of surgery (+33.2%, P = .019) after the shelter-in-place order, but we did not observe a change in any of the corresponding 30-day events. Conclusions The volume of shoulder arthroplasty for fracture dropped during the time of COVID-19. The reduction in volume could be due to less shoulder trauma due to shelter-in-place or a change in the indications for arthroplasty given the perceived higher risks associated with intubation and surgical care. We noted more patients undergoing shoulder arthroplasty for fracture were safely discharged on the day of surgery, suggesting this may be a safe practice that can be adopted moving forward. Level of Evidence Level III; Retrospective Case-control Comparative Study
Collapse
Affiliation(s)
- Mark T Dillon
- Department of Orthopedic Surgery, The Permanente Medical Group, Sacramento, CA, USA
| | - Priscilla H Chan
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA, USA
| | | | - Kathryn E Royse
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA, USA
| | | | - Kanu Okike
- Department of Orthopedic Surgery, Hawaii Permanente Medical Group, Honolulu, HI, USA
| | - Monti Khatod
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, West Los Angeles, CA, USA
| | - Ronald A Navarro
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, South Bay, CA, USA
| |
Collapse
|
12
|
Ezuma CO, Kosber RL, Kovacevic D. Biological sex impacts perioperative complications after reverse shoulder arthroplasty for proximal humeral fracture. JSES Int 2021; 5:371-376. [PMID: 34136842 PMCID: PMC8178601 DOI: 10.1016/j.jseint.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background The purpose of this study was to determine the difference in complication rates between males and females undergoing reverse shoulder arthroplasty for proximal humerus fractures. We hypothesized that (1) females were more likely to undergo reverse shoulder arthroplasty for fracture, and (2) males were more likely to sustain a perioperative complication. Methods The National Surgical Quality Improvement Program database was queried to identify patients who underwent reverse shoulder arthroplasty for proximal humerus fracture between 2011 and 2018. Patients were stratified based on biological sex. Patient demographics, comorbidities, and 30-day perioperative complication rates were collected. Univariate analyses and multiple variable logistic regression modeling were performed. Results About 905 patients were included in the analysis—175 (19.3%) were male and 730 (80.7%) were female. Males were more likely to sustain perioperative complications (26.3% vs. 14.1%; P < .001)—pneumonia (2.9% vs. 0.5%; P = .016), unplanned intubation (2.3% vs. 0.4%; P = .029), and unplanned reoperation (9.1% vs. 1.1%; P < .001). On multivariate analysis, males were at a 2.4-fold increase risk of developing any complication (OR = 2.38 [95% CI 1.55-3.65]; P < .001) and a 10-fold increase risk of returning to the operating room for an unplanned reoperation (OR = 10.59 [95% CI 4.23-27.49]; P < .001) compared with females. Conclusion Females were more likely to undergo reverse shoulder arthroplasty for proximal humerus fracture, but males were at increased risk of sustaining short-term complications. This study provides useful information for clinicians to consider when counseling their patients during the perioperative period.
Collapse
Affiliation(s)
- Chimere O Ezuma
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Rashed L Kosber
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - David Kovacevic
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| |
Collapse
|
13
|
Ahmed AF, Hantouly A, Toubasi A, Alzobi O, Mahmoud S, Qaimkhani S, Ahmed GO, Al Dosari MAA. The safety of outpatient total shoulder arthroplasty: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2021; 45:697-710. [PMID: 33486581 PMCID: PMC7892728 DOI: 10.1007/s00264-021-04940-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/07/2021] [Indexed: 11/09/2022]
Abstract
Purpose To meet the increasing demands of total shoulder arthroplasty (TSA) while reducing its financial burden, there has been a shift toward outpatient surgery. This systematic review and meta-analysis aimed to evaluate the safety of outpatient TSA. Methods The primary objective was to compare re-admission rates and postoperative complications in outpatient versus inpatient TSA. The secondary objectives were functional outcomes and costs. PubMed, Google Scholar, and Web of Science were searched until March 28, 2020. The inclusion criteria were studies reporting at least complications or readmission rates within a period of 30 days or more. Results Ten level III retrospective studies were included with 7637 (3.8%) and 192,025 (96.2%) patients underwent outpatient and inpatient TSA, respectively. Outpatient TSA had relatively younger and healthier patients. There were no differences between outpatient and inpatient arthroplasty for 30- and 90-day readmissions. Furthermore, unadjusted comparisons demonstrated significantly less total and major surgical complications, less total, major, and minor medical complications in favour of outpatient TSA. However, subgroup analyses demonstrated that there were no significant differences in all complication if the studies had matched controls and regardless of data source (database or nondatabase studies). The revision rates were similar between both groups at a 12–24 months follow-up. Two studies reported a significant reduction in costs in favour of outpatient TSA. Conclusion This study highlights that outpatient TSA could be a safe and effective alternative to inpatient TSA in appropriately selected patients. It was evident that outpatient TSA does not lead to increased readmissions, complications, or revision rates. A potential additional benefit of outpatient TSA was cost reduction. Supplementary Information The online version contains supplementary material available at 10.1007/s00264-021-04940-7.
Collapse
Affiliation(s)
- Abdulaziz F Ahmed
- Section of Orthopedics, Department of Surgery, Orthopaedic Surgery Resident, Hamad General Hospital, PO Box 3050, Doha, Qatar.
| | - Ashraf Hantouly
- Section of Orthopedics, Department of Surgery, Orthopaedic Surgery Resident, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Ammar Toubasi
- Section of Orthopedics, Department of Surgery, Orthopaedic Surgery Resident, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Osama Alzobi
- Section of Orthopedics, Department of Surgery, Orthopaedic Surgery Resident, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Shady Mahmoud
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Saeed Qaimkhani
- Section of Orthopedics, Department of Surgery, Orthopaedic Surgery Resident, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Ghalib O Ahmed
- Section of Orthopedics, Department of Surgery, Orthopaedic Surgery Resident, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Mohammed Al Ateeq Al Dosari
- Section of Orthopedics, Department of Surgery, Orthopaedic Surgery Resident, Hamad General Hospital, PO Box 3050, Doha, Qatar
| |
Collapse
|
14
|
Erickson BJ, Shishani Y, Jones S, Sinclair T, Bishop ME, Romeo AA, Gobezie R. Outpatient versus inpatient anatomic total shoulder arthroplasty: outcomes and complications. JSES Int 2020; 4:919-922. [PMID: 33345235 PMCID: PMC7738588 DOI: 10.1016/j.jseint.2020.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Total shoulder arthroplasty (TSA) is an effective treatment option for glenohumeral arthritis. Historically, this surgical procedure was performed on an inpatient basis. There has been a recent trend in performing TSA on an outpatient basis in the proper candidates. Methods All patients who underwent outpatient TSA performed by a single surgeon between 2015 and 2017 were included. Demographic information and clinical outcome scores, as well as data on complications, readmissions, and revision surgical procedures, were recorded. This group of patients was then compared with a matched cohort of patients who underwent inpatient TSA over the same period. Results Overall, 94 patients (average age, 60.4 years; 67.0% male patients) underwent outpatient TSA and were included. Patients who underwent outpatient TSA showed significant improvement in all clinical outcome scores at both 1 and 2 years postoperatively. The control group consisted of 77 patients who underwent inpatient TSA (average age, 62.6 years; 53.2% male patients). No significant differences in complications or improvements in clinical outcome scores were found between the inpatient and outpatient groups. Conclusion TSA performed in an outpatient setting is a safe and reliable procedure that provides significant improvement in clinical outcome scores and no difference in complication rates compared with inpatient TSA.
Collapse
Affiliation(s)
| | | | - Stacy Jones
- Cleveland Shoulder Institute, Beachwood, OH, USA
| | - Tia Sinclair
- Cleveland Shoulder Institute, Beachwood, OH, USA
| | | | - Anthony A Romeo
- Dupage Medical Group, Department of Orthopaedic Surgery, Joliet, IL, USA
| | | |
Collapse
|
15
|
A Novel Machine Learning Model Developed to Assist in Patient Selection for Outpatient Total Shoulder Arthroplasty. J Am Acad Orthop Surg 2020; 28:e580-e585. [PMID: 31663914 PMCID: PMC7180108 DOI: 10.5435/jaaos-d-19-00395] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Patient selection for outpatient total shoulder arthroplasty (TSA) is important to optimizing patient outcomes. This study aims to develop a machine learning tool that may aid in patient selection for outpatient total should arthroplasty based on medical comorbidities and demographic factors. METHODS Patients undergoing elective TSA from 2011 to 2016 in the American College of Surgeons National Surgical Quality Improvement Program were queried. A random forest machine learning model was used to predict which patients had a length of stay of 1 day or less (short stay). A multivariable logistic regression was then used to identify which variables were significantly correlated with a short or long stay. RESULTS From 2011 to 2016, 4,500 patients were identified as having undergone elective TSA and having the necessary predictive features and outcomes recorded. The machine learning model was able to successfully identify short stay patients, producing an area under the receiver operator curve of 0.77. The multivariate logistic regression identified numerous variables associated with a short stay including age less than 70 years and male sex as well as variables associated with a longer stay including diabetes, chronic obstructive pulmonary disease, and American Society of Anesthesiologists class greater than 2. CONCLUSIONS Machine learning may be used to predict which patients are suitable candidates for short stay or outpatient TSA based on their medical comorbidities and demographic profile.
Collapse
|
16
|
Bixby EC, Boddapati V, Anderson MJJ, Mueller JD, Jobin CM, Levine WN. Trends in total shoulder arthroplasty from 2005 to 2018: lower complications rates and shorter lengths of stay despite patients with more comorbidities. JSES Int 2020; 4:657-661. [PMID: 32939502 PMCID: PMC7479025 DOI: 10.1016/j.jseint.2020.04.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Total shoulder arthroplasty (TSA) is an increasingly common procedure. This study looked at trends in TSA using a nationwide registry, with a focus on patient demographics, comorbidities, and complications. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent TSA from 2005 to 2018. Cohorts were created based on year of surgery: 2005-2010 (N = 1116), 2011-2014 (N = 5920), and 2015-2018 (N = 16,717). Patient demographics, comorbidities, operative time, hospital length of stay, discharge location, and complications within 30 days of surgery were compared between cohorts using bivariate and multivariate analysis. Results Bivariate analysis revealed significantly more comorbidities among patients in the 2015-2018 cohort compared with the 2005-2010 cohort, specifically American Society of Anesthesiologist class III or IV (57.0% vs. 44.3%, P < .001), morbid obesity (10.8% vs. 7.8%, P < .001), diabetes (17.8% vs. 12.1%, P < .001), and chronic obstructive pulmonary disease (6.7% vs. 4.1%, P = .003). The use of regional anesthesia has decreased (5.6% in 2005-2010 vs. 2.8% in 2015-2018, P < .001), as has operative time (▵: −16 minutes, P < .001) and length of stay (▵: −0.6 days, P < .001). There were also significant decreased rates of perioperative blood transfusion (OR [odds ratio], 0.46), non-home discharge (OR, 0.79), urinary tract infection (OR, 0.47), and sepsis (OR, 0.17), (P < .001 for all comparisons) between the 2005-2010 and 2015-2018 cohorts. Conclusions Between 2005 and 2018, patients undergoing TSA had increasingly more comorbidities but experienced lower rates of short-term complications, in the context of shorter hospitalizations and more frequent discharge to home.
Collapse
Affiliation(s)
- Elise C Bixby
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Venkat Boddapati
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Matthew J J Anderson
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - John D Mueller
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Charles M Jobin
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - William N Levine
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| |
Collapse
|
17
|
Borakati A, Ali A, Nagaraj C, Gadikoppula S, Kurer M. Day case vs inpatient total shoulder arthroplasty: A retrospective cohort study and cost-effectiveness analysis. World J Orthop 2020; 11:213-221. [PMID: 32405470 PMCID: PMC7206195 DOI: 10.5312/wjo.v11.i4.213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/24/2020] [Accepted: 03/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Day case total shoulder arthroplasty (TSA) is a novel approach, not widely practiced in Europe. We conducted a retrospective cohort study of patients comparing elective day case and inpatient TSAs in our United Kingdom centre.
AIM To evaluate the efficacy and cost-effectiveness of day case TSA compared to standard inpatient total shoulder arthroplasty.
METHODS All patients undergoing TSA between January 2017 and July 2018 were included. Outcome measures were: Change in abduction and extension 3 mo postoperatively; 30-d postoperative adverse events and re-admissions in day case and inpatient groups. We also conducted an economic evaluation of outpatient arthroplasty. Multivariate linear and logistic regression were used to adjust for demographic and operative covariates.
RESULTS Fifty nine patients were included, 18 d cases and 41 inpatients. There were no adverse events or re-admissions at 30 d postoperatively in either group. There were no significant differences in adjusted flexion (mean difference 16.4, 95%CI: 17.6-50.5, P = 0.337) or abduction (mean difference: 13.2, 95%CI: 18.4-44.9, P = 0.405) postoperatively between groups. Median savings with outpatient arthroplasty were £529 (interquartile range: 247.33-789, P < 0.0001).
CONCLUSION Day case TSA is a safe, effective procedure, with significant cost benefit. Wider use may be warranted in the United Kingdom and beyond, with potential for significant cost savings and improved efficiency.
Collapse
Affiliation(s)
- Aditya Borakati
- Division of Surgery and Interventional Science, Royal Free Hospital and University College London, London NW3 2QG, United Kingdom
| | - Asad Ali
- Department of Trauma and Orthopaedics, North Middlesex University Hospital, London N18 1QX, United Kingdom
| | - Chetana Nagaraj
- Department of Anaesthesia, North Middlesex University Hospital, London N18 1QX, United Kingdom
| | - Srinivas Gadikoppula
- Department of Trauma and Orthopaedics, North Middlesex University Hospital, London N18 1QX, United Kingdom
| | - Michael Kurer
- Department of Trauma and Orthopaedics, North Middlesex University Hospital, London N18 1QX, United Kingdom
| |
Collapse
|
18
|
Burton BN, Finneran JJ, Angerstein A, Ross E, Mitchell A, Waterman RS, Elsharydah A, Said ET, Gabriel RA. Demographic and clinical factors associated with same-day discharge and unplanned readmission following shoulder arthroplasty: a retrospective cohort study. Korean J Anesthesiol 2020; 74:30-37. [PMID: 32160738 PMCID: PMC7862930 DOI: 10.4097/kja.19471] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/10/2020] [Indexed: 12/15/2022] Open
Abstract
Background Same-day discharge, defined as discharge from the hospital within 24 h of surgery, has been shown to be safe for joint arthroplasty. We examined demographic and clinical factors associated with same-day discharge and unplanned readmission following shoulder arthroplasty in adult patients. Methods Utilizing data from the American College of Surgeons National Surgical Quality Improvement Program database, we extracted information of all patients that underwent shoulder arthroplasty. The primary and secondary outcome of interest was same-day discharge and 30-day unplanned readmission, respectively. We utilized multivariable logistic regression to identify covariates associated with these outcomes. Results There were 17,011 patients analyzed when identifying predictors for same-day discharge. There was an increase in same-day discharge from 2007 to 2016. The odds of same-day discharge were significantly better for males (P < 0.001). The odds of same-day discharge was significantly decreased for every 10-year increase in age and for patients with insulin dependent diabetes, poor functional status, chronic obstructive pulmonary disease, congestive heart failure (CHF), bleeding disorder, and comorbidity burden (all P < 0.001). There were 14,276 patients analyzed for hospital readmission. The odds of unplanned readmission were significantly higher for every 10-year increase in age and for patients with poor functional status, CHF, bleeding disorder, and higher comorbidity burden (all P < 0.005). Conclusions The results of this study show that preoperative comorbidities and advanced age reduce the odds of same-day discharge. Risk stratification, preoperative optimization, and coordinated care after surgery may be helpful to optimize patients for same-day discharge.
Collapse
Affiliation(s)
- Brittany N Burton
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - John J Finneran
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Aaron Angerstein
- Department of Biological Sciences, University of California San Diego, La Jolla, CA, USA
| | - Evelyn Ross
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Ana Mitchell
- Department of Radiology, University of California Davis, Sacramento, CA, USA
| | - Ruth S Waterman
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Ahmad Elsharydah
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Engy T Said
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Rodney A Gabriel
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA.,Department of Medicine, Division of Biomedical Informatics, University of California San Diego, La Jolla, CA, USA
| |
Collapse
|