Same-Day Discharge vs. Inpatient Total Shoulder Arthroplasty: An Age Stratified Comparison of Postoperative Outcomes and Hospital Charges

Yazdan Raji; Kira L Smith; Mark Megerian; Bhargavi Maheshwer; Abdus Sattar; Raymond E Chen; Robert J Gillespie

doi:10.1016/j.jse.2024.02.040

Same-Day Discharge vs. Inpatient Total Shoulder Arthroplasty: An Age Stratified Comparison of Postoperative Outcomes and Hospital Charges

J Shoulder Elbow Surg. 2024 Apr 9:S1058-2746(24)00242-8. doi: 10.1016/j.jse.2024.02.040. Online ahead of print.

Authors

Yazdan Raji¹, Kira L Smith², Mark Megerian³, Bhargavi Maheshwer⁴, Abdus Sattar³, Raymond E Chen⁵, Robert J Gillespie⁵

Affiliations

¹ Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. Electronic address: yazdan.raji@uhhospitals.org.
² Sports Medicine Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
³ Case Western Reserve University School of Medicine, Cleveland, OH, USA.
⁴ Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
⁵ Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Sports Medicine Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA.

PMID: 38604401
DOI: 10.1016/j.jse.2024.02.040

Abstract

Background: As the number of total shoulder arthroplasty (TSA) procedures increases, there is a growing interest in improving patient outcomes, limiting costs, and optimizing efficiency. One approach has been to transition these surgeries to an outpatient setting. Therefore, the purpose of this study was to conduct an age-stratified analysis comparing the 90-day postoperative outcomes of primary TSA in the same-day discharge (SDD) and inpatient (IP) settings with a specific focus on the super-elderly.

Methods: This retrospective study included all patients who underwent primary anatomic or reverse TSA between January 2018 and December 2021 in ambulatory and inpatient settings. The outcome measures included LOS, complications, hospital charges, ED utilization, readmissions, and reoperations within 90-days following TSA. Patients with LOS ≤8 hours were considered as SDD, and those with LOS >8 hours were considered as IP. P <0.05 was considered statistically significant.

Results: There were 121 and 174 procedures performed in SDD and IP settings, respectively. There were no differences in comorbidity indices between the SDD and IP groups (ASA score P=0.12, ECI P=0.067). The SDD cohort was younger than the IP group (SDD 67.0 years vs. 73.0 IP years, P<0.001), and the SDD group higher rate of intraoperative tranexamic acid use (P=0.015) and lower estimated blood loss (P=0.009). There were no differences in 90-day overall minor (P=0.20) and major complications (P=1.00), ED utilization (P=0.63), readmission (P=0.25) or reoperation (P =0.51) between the SDD and IP groups. When stratified by age, there were no differences in overall major (P=0.80) and minor (P=0.36) complications among the groups. However, the LOS was directly correlated with increasing age (LOS=8.4 hours in ≥65 to < 75-year cohort vs. LOS=25.9 hours in ≥80-year cohort; P<0.001). There were no differences in hospital charges between SDD and IP primary TSA in all 3 age groups (P=0.82).

Conclusion: SDD TSA has a shorter LOS without increasing postoperative major and minor complications, ED encounters, readmissions, or reoperations. Older age was not associated with an increase in the complication profile or hospital charges even in the SDD setting, although it was associated with increased LOS in the IP group. These results suggest that TSA can be safely performed expeditiously in an outpatient setting.

Level of evidence: Level III; Retrospective Comparative Study.

Keywords: hospital charges; outcomes; safety; same-day discharge; shoulder arthroplasty.