Pain and falls among top reasons for early return to care following primary elective shoulder arthroplasty in a United States cohort

Abstract

BackgroundLittle is known regarding reasons for return to the emergency department (ED) or readmission following primary shoulder arthroplasty, especially immediately after discharge and for same-day discharge patients. We sought to identify primary reasons for return to care after this procedure. MethodsWe conducted a descriptive study comprising patients aged ≥18 years who underwent primary elective shoulder arthroplasty from 2009 to 2018 and subsequently had a 90-day ED-only visit or readmission. Patients were identified using our integrated health care system’s shoulder arthroplasty registry, and primary return reasons were determined through manual electronic health record review. Frequencies and proportions were used to describe reasons for 90-day ED and readmission returns, while subcategorizing by surgical and medical reasons. Return reasons were also reported by timing of the postdischarge return and by same-day discharge vs. inpatient stay. ResultsOf 9976 primary elective shoulder arthroplasty patients, 1261 (12.6%) had an ED visit, and 465 (4.7%) had a readmission. Over half (52.9%) of all 90-day ED visits were for reasons related to the procedure, while only a little over a third (35.5%) of all 90-day readmissions were surgically related. The top reasons for 90-day ED visits were postoperative pain, falls, and other nonsurgically treated musculoskeletal complaints. Pain, genitourinary complaints, and pulmonary complaints were the most frequent reasons for ED visit within 2 days of discharge, whereas postoperative pain and falls were the top reasons for ED visit specifically following same-day discharge. The top reasons for 90-day readmissions were all medical related: gastrointestinal, cardiovascular, and pulmonary. Pain related to the procedure, pulmonary complaints, and gastrointestinal complaints were the most frequent reasons for readmission within 2 days of discharge. Almost three-fourths of readmissions following same-day discharge were for medical reasons. ConclusionKnowledge of underlying reasons for returns following shoulder arthroplasty is crucial to improve patient safety, satisfaction, and comfort. While postoperative pain remains an obvious problem, a large proportion of patients also returned to the ED owing to falls. As most ED returns were related to the postoperative surgical care pathway, these returns may potentially be reduced with improved preoperative planning measures.