Predictors of extended length of stay after elective shoulder arthroplasty

Abstract

With policymakers and hospitals increasingly looking to cut costs, length of stay after surgery has come into focus as an area for improvement. Despite the increasing popularity of total shoulder arthroplasty, there is limited research about the factors contributing to prolonged hospital stay. We sought to identify preoperative and postoperative predictors of prolonged hospital stay in patients undergoing anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA). Using the 2011 Nationwide Inpatient Sample, we identified an estimated 40,869 patients who underwent elective total shoulder arthroplasty (62.5% ATSA; 37.5% RTSA) and separated them into those with normal length of stay (<75th percentile) and prolonged length of stay (>75th percentile). Multivariate logistic regression modeling was performed to identify factors associated with prolonged length of stay. Patient-level factors associated with prolonged length of stay common to patients undergoing ATSA or RTSA included increasing age, female sex, congestive heart failure, renal failure, chronic pulmonary disease, and preoperative anemia. Provider-related factors were lower volume and location in the South or Northeast. Postoperative complications showed a significant influence as well. Our data can be used to promptly identify patients at higher risk of prolonged hospitalization after elective shoulder arthroplasty and to ultimately improve quality of care and cost containment.