Predictors for failed same-day discharge after total shoulder arthroplasty

Area of Science:

• Orthopedic Surgery
• Health Services Research

Background:

• Same-day discharge (SDD) after total shoulder arthroplasty (TSA) is increasingly common with ambulatory surgery expansion.
• Prolonged hospital stays increase costs without improving outcomes.
• Identifying risk factors for SDD failure is crucial for patient selection and care pathway optimization.

Purpose of the Study:

• To evaluate risk factors associated with failure of same-day discharge (SDD) after total shoulder arthroplasty (TSA).

Main Methods:

• Retrospective review of 808 patients undergoing primary TSA (September 2016 - August 2025).
• Exclusion of hemiarthroplasty and revision arthroplasty cases.
• Logistic regression analysis to identify predictors of SDD failure (discharge >24 hours), controlling for demographics, comorbidities, and intraoperative factors.

Main Results:

• 46% of patients (377/808) achieved SDD.
• American Society of Anesthesiology (ASA) physical status was the only significant predictor of SDD failure (P < .001).
• SDD failure rates increased with ASA class: 20% (ASA 1), 36% (ASA 2), 49% (ASA 3), and 71% (ASA 4).

Conclusions:

• ASA classification is a significant predictor of SDD failure after TSA.
• Patients with ASA Class 3 and 4 are at high risk for prolonged length of stay (>24 hours).
• Findings aid in optimizing outpatient surgical pathways, patient counseling, and reducing healthcare costs.