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Related Experiment Video

Updated: Jul 12, 2026

Reverse Total Shoulder Arthroplasty
10:10

Reverse Total Shoulder Arthroplasty

Published on: July 5, 2011

Predictors for failed same-day discharge after total shoulder arthroplasty.

Jonathan A Marter1, Kathleen C Smith1, Mina Entessari2

  • 1Wake Forest University School of Medicine, Winston-Salem, NC, USA.

Journal of Shoulder and Elbow Arthroplasty
|July 11, 2026
PubMed
Summary

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Same-day discharge (SDD) after total shoulder arthroplasty (TSA) is feasible for many patients. However, American Society of Anesthesiology (ASA) physical status significantly predicts SDD failure, with higher ASA classes indicating increased risk.

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.
Keywords:
Anesthesia scoreLength of stayOutpatient surgeryPre-operative risk factorsSame-day dischargeShoulder arthroplasty

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Reverse Total Shoulder Arthroplasty
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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.