Association Between Same-Day Discharge Shoulder Arthroplasty and Risk of Adverse Events in Patients with American Society of Anesthesiologists Classification ≥ 3: A Cohort Study.

Abstract

Same-day discharge for shoulder arthroplasty (SA) is well-supported in the literature, however, most studies have focused on healthier patients. Indications for same-day discharge SA have expanded to include patients with more comorbidities, but safety of same-day discharge in this population remains unknown. We sought to compare outcomes following same-day discharge versus inpatient SA in a cohort of patients considered higher-risk for adverse events, defined as an American Society of Anesthesiologists (ASA) classification of ≥3. Data from a US-based healthcare system's SA registry were utilized to conduct a retrospective cohort study. All patients with an ASA classification of ≥3 who underwent primary elective anatomic or reverse SA in a hospital from 2018-2020 were included. The exposure of interest was in-hospital length of stay: same-day discharge versus ≥1-night hospital inpatient stay. The likelihood of 90-day post-discharge events, including emergency department (ED) visit, readmission, cardiac complication, venous thromboembolism (VTE), and mortality, was evaluated using propensity score-weighted logistic regression with noninferiority testing using a margin of 1.10. The cohort included a total of 1,814 SA patients, of whom 1,005 (55.4%) had same-day discharge. In propensity score-weighted models, same-day discharge was not inferior to an inpatient stay SA regarding 90-day readmission (odds ratio [OR]=0.64, one-sided 95% upper bound [UB]=0.89) and overall complications (OR=0.67, 95% UB=1.00). We lacked evidence in support of non-inferiority for 90-day ED visit (OR=0.96, 95% UB=1.18), cardiac event (OR=0.68, 95% UB=1.11), or VTE (OR=0.91, 95% UB=2.15). Infections, revisions for instability, and mortality were too rare to evaluate using regression analysis. In a cohort of over 1,800 patients with an ASA of ≥3, we found same-day discharge SA did not increase the likelihood of ED visits, readmissions, or complications compared with an inpatient stay and same-day discharge was not inferior to an inpatient stay with regard to readmissions and overall complications. These findings suggest that it is possible to expand indications for same-day discharge SA in the hospital setting.