Effect of hospital length of stay on functional outcomes and readmission after total shoulder arthroplasty

Abstract

BackgroundTotal shoulder arthroplasty (TSA) is a common orthopedic procedure for glenohumeral osteoarthritis, rotator cuff arthropathy, and other degenerative conditions. The current standard hospital length of stay (LOS) commonly accepted following TSA is 1-2 days before discharge to home or a private facility. To evaluate the association between LOS and readmissions, revisions, and outcomes. Additionally, risk factors for increased LOS (> 24 hours) following TSA will be determined. MethodsA retrospective review identified all patients who underwent TSA between 2010 and 2019. Patients were excluded for chronic kidney disease requiring dialysis, preoperative corticosteroid use, revision TSA, undergoing a TSA for a fracture, or having no recorded outcome measures. Demographic information, operative details, medical comorbidities, length of hospital stay, complications, location of discharge, readmissions, revisions, and outcome scores were collected. Patients were categorized into two groups: discharge within 24 hours of TSA and discharge over 24 hours after TSA. ResultsPatients discharged within 24 hours had an average LOS of 0.96 ± 0.19 days, and patients discharged after 24 hours had an average LOS of 2.71 ± 1 day (P < .001). There were no significant differences in the groups with regard to race, sex, and body mass index. Patients discharged within 24 hours were younger at the time of surgery compared to patients discharged after 24 hours (66.7 ± 8.10 years and 70.1 ± 10.4 years, respectively [P = .030]). There was a significant difference in discharge location between the groups with 86.2% of patients in the under-24 hour group being discharged to home compared to only 66.0% in the over-24 hour group (P = .006). There were no significant differences between the groups with regard to postoperative complication rate, 90-day readmission rate, and need for revision procedures. There was a significant difference in the Charlson comorbidity index between the groups with those discharged within 24 hours averaging an index score of 2.78 ± 1.33 and those discharged after 24 hours averaging an index score of 4.02 ± 2.07 (P < .001). No significant differences were found between preoperative and postoperative American Shoulder and Elbow Surgeons Shoulder Survey, Single Assessment Numeric Evaluation, or Simple Shoulder Test scores between the groups. ConclusionPatients who had a hospital LOS over 24 hours following TSA were significantly older and discharged to nonhome locations at a higher rate. Patients with Charlson comorbidity index scores over 3 are more likely to have a LOS over 24 hours following TSA. Postoperative outcome measures were not affected by LOS with no significant differences in readmission rate, revision rates, and complications.