Nonhome discharge is an independent risk factor for readmission after primary total shoulder arthroplasty

Use of total shoulder arthroplasty (TSA) in the United States has increased substantially within the last 2 decades, and this trend is expected to continue. As TSA volume has continued to increase, health care policy has shifted toward an emphasis on value-based care. Therefore, it is important to understand variables that may increase TSA costs, including readmission rates. Patients discharged to home health care (HHC) or post-acute care (PAC) facilities have demonstrated increased readmission rates after TSA. However, few studies have directly compared HHC with PAC facilities and routine home discharge while accounting for pertinent demographics. The purpose of this study was to compare 180-day readmission rates between routine home discharge, HHC, and PAC facility groups after primary TSA.

The Nationwide Readmissions Database was queried from 2010 to 2020 to identify all patients who underwent primary TSA. Readmission rates were compared between routine home discharge, HHC, and PAC facility groups. Binary logistic regression identified independent risk factors for readmission within 180 days.

From 2010 to 2020 a total of 171,898 patients underwent TSA. Of them, 71% were routinely discharged home, 21% were discharged to HHC, and 8% were discharged to a PAC facility. After adjusting for income, insurance, obesity status, age, Charlson Comorbidity Index, and gender, discharge to a PAC facility was independently predictive of readmission within 180 days after TSA (odds ratio: 1.69, 95% confidence interval: 1.59-1.79, P < .001).

Patients discharged to a PAC facility after TSA had higher readmission rates than HHC and routine home discharges that persisted even after controlling for relevant demographics. Clinicians should be cognizant of the risks and benefits of different discharge methods and consider home discharges for suitable candidates. Understanding risk factors that increase health care expenditures has significant utility for institutions in the era of bundled care. However, it is important that alternative payment models do not disincentivize orthopedic surgeons from providing care to medically complex patients.