Predicting successful outpatient total shoulder arthroplasty.

Area of Science:

• Orthopedic Surgery
• Patient Outcomes
• Health Informatics

Background:

• Total shoulder arthroplasty (TSA) is increasingly performed as an outpatient procedure.
• Patient selection for outpatient TSA often relies on surgeon judgment or institutional guidelines.
• A risk calculator was developed to predict successful outpatient TSA based on patient factors.

Purpose of the Study:

• To retrospectively assess the utility of a publicly available shoulder arthroplasty outpatient appropriateness risk calculator at a single institution.
• To evaluate the calculator's accuracy in predicting same-day discharge after TSA.
• To compare outcomes between inpatient and outpatient TSA procedures.

Main Methods:

• Retrospective review of 282 patients undergoing anatomic TSA between January 2018 and March 2021.
• Data collected included demographics, comorbidities, ASA classification, and surgery duration.
• Patient data were input into the risk calculator; outcomes like complications, reoperations, and readmissions were analyzed.

Main Results:

• The risk calculator's performance in predicting same-day discharge was poor (Area Under Curve = 0.55), similar to chance.
• No significant differences were found in age, Charlson Comorbidity Index, or ASA class between inpatient and outpatient groups.
• Complication rates, readmissions, and reoperations were low and did not differ significantly between inpatient and outpatient TSA.

Conclusions:

• The shoulder arthroplasty risk calculator demonstrated limited utility in predicting outpatient discharge.
• Outpatient TSA procedures were associated with low complication rates, comparable to inpatient procedures.
• Surgeon experience may be as valuable as risk calculators for discharge decisions in outpatient TSA.