Postoperative Day 1 Discharge Following Elective Shoulder Arthroplasty

Abstract

BackgroundThe number of shoulder arthroplasty procedures performed has greatly increased in recent years and this trend is expected to continue. However, accelerated recoveries by way of reduced postoperative hospital stays have not been studied for this patient population as extensively as in the hip and knee arthroplasty literature. The average length of stay for shoulder arthroplasty patients has consistently been found to be between 2 and 2.5 days. We conducted a study to determine whether postoperative day 1 (POD1) discharge would put patients at increased risk for complications and readmission following elective shoulder arthroplasty. MethodsA retrospective review of patients who underwent shoulder arthroplasty (reverse or anatomic total shoulder arthroplasty) performed by one surgeon at one institution from 2008 to 2015 was conducted. All elective primary shoulder arthroplasty patients were included. Exclusion criteria included revision arthroplasty, humeral head replacement, humeral head resurfacing, and arthroplasty for fracture. Patient demographics, medical comorbidities, postoperative length of stay, hospital readmission within 30 days of discharge, and reason for readmission were collected. The 30-day readmission rate was the primary outcome used in determination of the safety of this practice. ResultsA total of 353 patients were found to meet our criteria, of which 205 (58.1%) were discharged on POD1. A total of 83 patients were discharged on postoperative day 2 or 3 (POD2-3) from 2008 to 2011. Of those discharged on POD1, 8 were found to have been readmitted to the hospital within 30 days of original discharge to give an overall readmission rate of 3.90%. The most common reason for readmission was dyspnea (3/8, 37.5%). No risk factors were found to be associated with increased likelihood of readmission in this patient group. There were 4 readmissions in the POD2-3 discharge group to give an overall readmission rate of 4.82% (4/83). No statistically significant difference was found between 30-day readmission rates of POD1 and POD2-3 discharge elective shoulder arthroplasty patients in this study or shoulder arthroplasty patients in general from other studies (P > .100). ConclusionPOD1 discharge following elective shoulder arthroplasty does not increase the risk for postoperative complications requiring hospital readmission. With shorter hospital stays, POD1 discharge following elective shoulder arthroplasty could provide a method to reduce healthcare expenditures.