Distance traveled is not associated with rate of same-day discharge after primary total shoulder arthroplasty

Cost conservation and value are major components of orthopedic surgery and health economics. One measure frequently used by surgeons to mitigate cost is the utilization of same-day discharge (SDD) after total shoulder arthroplasty (TSA). With SDD, we must also identify patient factors that support its safety and suitability. The purpose of this study was to investigate if patient travel distance is associated with safe SDD. Secondarily, we aimed to identify other patient factors associated with safe SDD.

This retrospective review included all patients undergoing primary anatomic or reverse TSA by a single surgeon at a single institution between January 2021 and June 2024 in a hospital setting. Patient demographic information, medical comorbidities, surgical factors, and distance in miles to the hospital were collected. Patients were placed into 2 groups: those discharged the same day as surgery and those requiring ≥ 1 night hospital stay. Outcomes collected included implant complications, 90-day emergency department utilization, and 90-day readmissions.

691 patients met inclusion criteria. Of these, 358 were SDD, while 333 stayed ≥ 1 night. There was no association between distance traveled and SDD. Patients who were admitted were older (73.12 vs. 69.14; P < .001), more frequently women (63.1% vs. 44.7%; P < .001), less likely to be independent ambulators (70.3 % vs. 82.4%; P < .001), and more likely to live alone (24.6% vs. 11.7%; P < .001). Patients admitted for ≥ 1 night stay were also more likely to have a higher American Society of Anesthesiologists (ASA) score, have history of diabetes mellitus, hypertension, coronary artery disease, and chronic kidney disease. Of all significant factors, age, female gender, level of assistance at home, and ASA III remained significantly associated with hospital admission on multivariate testing. There was no difference between the 2 groups regarding implant complications, 90-day emergency department utilization, or 90-day readmissions.

The decision for SDD after TSA is multifactorial, but is not associated with the distance traveled by the patient to the hospital. Increased age, female gender, use of cane for ambulation, and ASA III are independently associated with the need for hospital admission after TSA. Living with a spouse is independently associated with SDD.