Total Shoulder Arthroplasty: Is Less Time in the Hospital Better?

Kyle R Duchman; Chris A Anthony; Robert W Westermann; Andrew J Pugely; Yubo Gao; Carolyn M Hettrich

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Total Shoulder Arthroplasty: Is Less Time in the Hospital Better?

Journal article

Open access

Peer reviewed

Total Shoulder Arthroplasty: Is Less Time in the Hospital Better?

Kyle R Duchman, Chris A Anthony, Robert W Westermann, Andrew J Pugely, Yubo Gao and Carolyn M Hettrich

The Iowa orthopaedic journal, Vol.37, pp.109-116

2017

PMCID: PMC5508292

PMID: 28852344

Appears in Diamond Open Access

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508292/View

Published (Version of record) Open Access

Abstract

The incidence of total shoulder arthroplasty (TSA) has increased significantly over the last decade. Short-stay protocols for other highvolume procedures have been shown to be safe and effective but have yet to be fully explored for TSA. Our purpose in comparing short-stay and inpatient TSA was to determine: (1) patient demographics and comorbidities, (2) 30-day morbidity, mortality, and readmissions using a matched analysis, and (3) independent predictors of 30-day complications. The American College of Surgeons National Surgical Quality Improvement (ACS NSQIP) database was queried and all patients undergoing elective, primary TSA between 2006 and 2013 were identified. Patients were categorized as short-stay or inpatient based on day of discharge. Propensity score matching was used to adjust for selection bias. Univariate and multivariate statistical analysis was used to compare 30-day morbidity and mortality between the two cohorts. Overall, 4,619 cases were available, with inpatient admission occurring in 65.7% of patients. Prior to propensity score matching, short-stay patients were significantly younger, more frequently male, with fewer comorbid conditions. After matching, inpatient admission was associated with increased rates of urinary tract infection (1.1% vs. 0.1%; p = 0.001), blood transfusion (5.3% vs. 0.8%; p < 0.001), and total complications (4.7% vs. 1.8%; p < 0.001). Multivariate analysis identified inpatient admission as an independent risk factor for 30-day complication following TSA. Short-stay TSA is a safe option for the appropriately selected patient. Inpatient admission was an independent risk factor for complication following TSA. Level of Evidence: III.

Length of Stay

Arthroplasty, Replacement, Shoulder - methods

Humans

Middle Aged

Risk Factors

Postoperative Complications - prevention & control

Male

Treatment Outcome

Postoperative Complications - epidemiology

Incidence

Shoulder Joint - surgery

Time Factors

Aged, 80 and over

Female

Aged

Retrospective Studies

Arthroplasty, Replacement, Shoulder - adverse effects

Details

Title: Subtitle: Total Shoulder Arthroplasty: Is Less Time in the Hospital Better?
Creators: Kyle R Duchman - Department of Orthopaedics & Rehabilitation,University of Iowa Hospitals and Clinics Iowa City,Iowa
Chris A Anthony - Department of Orthopaedics & Rehabilitation,University of Iowa Hospitals and Clinics Iowa City,Iowa
Robert W Westermann - Department of Orthopaedics & Rehabilitation,University of Iowa Hospitals and Clinics Iowa City,Iowa
Andrew J Pugely - Department of Orthopaedics & Rehabilitation,University of Iowa Hospitals and Clinics Iowa City,Iowa
Yubo Gao - Department of Orthopaedics & Rehabilitation,University of Iowa Hospitals and Clinics Iowa City,Iowa
Carolyn M Hettrich - Department of Orthopaedics & Rehabilitation,University of Iowa Hospitals and Clinics Iowa City,Iowa
Resource Type: Journal article
Publication Details: The Iowa orthopaedic journal, Vol.37, pp.109-116
Publisher: Dept. of Orthopaedics, The University of Iowa; United States
PMID: 28852344
PMCID: PMC5508292
ISSN: 1541-5457
eISSN: 1555-1377
Language: English
Date published: 2017
Academic Unit: Orthopedics and Rehabilitation; Internal Medicine; Athletic Training Program
Record Identifier: 9984040364902771

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