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

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.