Hospital Readmission Rates Following Outpatient Versus Inpatient Shoulder Arthroplasty

Area of Science:

• Orthopedic Surgery
• Patient Outcomes Research
• Health Services Research

Background:

• Outpatient total shoulder arthroplasty (TSA) is a growing trend, but data comparing its outcomes to inpatient TSA are limited.
• Understanding perioperative outcomes is crucial for determining the safety and efficacy of outpatient TSA.
• Controlled studies are needed to assess readmission rates and complication profiles.

Purpose of the Study:

• To compare 30-day all-cause hospital readmission rates between patients undergoing inpatient and outpatient total shoulder arthroplasty (TSA).
• To evaluate differences in readmission for surgical complications between the two surgical settings.
• To identify potential risks associated with outpatient TSA.

Main Methods:

• Utilized the National Surgical Quality Improvement Program (NSQIP) database (2010-2017) for primary and revision TSA cases.
• Employed 1:1 propensity score matching to control for patient demographics and comorbidities.
• Analyzed 1714 matched pairs of inpatient and outpatient TSA patients.

Main Results:

• Outpatient TSA had a significantly higher 30-day all-cause readmission rate (3.4%) compared to inpatient TSA (1.7%) (P<.01).
• Readmission rates for surgical complications were similar: 1.9% for outpatient vs. 1.4% for inpatient (P=.32).
• Propensity score matching controlled for key variables including age, sex, ASA classification, and comorbidities.

Conclusions:

• Patients undergoing outpatient TSA face an increased risk of all-cause 30-day readmission compared to matched inpatient counterparts.
• Despite higher overall readmissions, the risk of readmission specifically for surgical complications did not differ significantly.
• Emphasizes the critical importance of meticulous patient selection for outpatient total shoulder arthroplasty to mitigate postoperative admission risks.