Factors Associated With Readmission and Reoperation After Total Shoulder Arthroplasty

Area of Science:

• Orthopedic Surgery
• Patient Safety
• Health Services Research

Background:

• Unplanned readmission and reoperation are significant concerns following total shoulder arthroplasty (TSA).
• Identifying risk factors is crucial for improving patient outcomes and optimizing perioperative care in TSA.

Purpose of the Study:

• To assess patient demographics, comorbidities, and procedural factors associated with 30-day unplanned readmission after TSA.
• To identify risk factors linked to 30-day unplanned reoperation following anatomic or reverse TSA.

Main Methods:

• Utilized the American College of Surgeons National Surgical Quality Improvement Program database (2013-2023).
• Included patients undergoing primary anatomic or reverse TSA (CPT code 23472).
• Employed Wilcoxon rank sum, chi-square tests, and multivariable logistic regression to analyze perioperative variables.

Main Results:

• Identified 45,893 primary TSA cases with 2.74% readmissions and 1.31% reoperations.
• Readmission risk factors included older age, longer operative time, longer hospital stay, inpatient status, ASA class 4, specific races, functional dependence, smoking, CHF, steroid use, bleeding disorders, IDDM, and anemia.
• Reoperation risk factors included male sex, higher BMI, longer operative time, longer hospital stay, inpatient status, functional dependence, smoking, and anemia.

Conclusions:

• Identified key patient-specific variables associated with increased risk of unplanned readmission and/or reoperation post-TSA.
• Understanding these risk factors aids clinical decision-making for TSA procedures.
• Highlights the need for targeted postoperative monitoring for high-risk patients undergoing TSA.