Identifying risk factors for 30-day readmission after outpatient total shoulder arthroplasty to aid in patient selection
Background: A recent meta-analysis comparing inpatient and outpatient total shoulder arthroplasty (TSA) showed no statistically significant differences in complications, readmissions, revisions, and infections. However, there remains no research on the appropriate patient selection for outpatient TS...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-11-01
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| Series: | JSES International |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666638323001615 |
| _version_ | 1797647769206259712 |
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| author | Kenny Ling, MD Nicholas Tsouris, MD Alireza Nazemi, MD, MS David E. Komatsu, PhD Edward D. Wang, MD |
| author_facet | Kenny Ling, MD Nicholas Tsouris, MD Alireza Nazemi, MD, MS David E. Komatsu, PhD Edward D. Wang, MD |
| author_sort | Kenny Ling, MD |
| collection | DOAJ |
| description | Background: A recent meta-analysis comparing inpatient and outpatient total shoulder arthroplasty (TSA) showed no statistically significant differences in complications, readmissions, revisions, and infections. However, there remains no research on the appropriate patient selection for outpatient TSA surgeries. This retrospective review seeks to aid surgeons in refining a safe patient selection algorithm by evaluating risk factors through a large database analysis of TSA surgeries. Methods: Patients who underwent TSA between 2015 and 2020 were identified in the National Surgical Quality Improvement Program database. Patients with a hospital stay of 0 days were designated as outpatient procedures. Multivariate analyses were used to determine risk factors for 30-day readmission following outpatient TSA and whether risk factors remained significant following overnight hospital stay. Results: A total of 2431 outpatient TSA patients were identified. The incidence of 30-day readmission was 1.8%. The majority of readmissions were due to pulmonary complications. The clinically significant risk factors for 30-day readmission were chronic steroid use (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.34-9.43; P = .011), chronic obstructive pulmonary disease (COPD) (OR 3.11, 95% CI 1.16-8.34; P = .024), and current smoking status (OR 2.27, 95% CI 1.02-5.03; P = .045). After overnight hospital stay, chronic steroid use and current smoking status were not significant, but COPD remained significant. Conclusion: Patients with chronic steroid use, COPD, or current smoking status are at increased risk for 30-day readmission. Inpatient hospital stay appears to benefit patients with chronic steroid use and current smoking status. Patients with COPD should be admitted for inpatient stay postoperatively but may still have high 30-day readmission rates following discharge. |
| first_indexed | 2024-03-11T15:22:14Z |
| format | Article |
| id | doaj.art-98d26d128587462a9685e4c1e8d743c9 |
| institution | Directory Open Access Journal |
| issn | 2666-6383 |
| language | English |
| last_indexed | 2024-03-11T15:22:14Z |
| publishDate | 2023-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JSES International |
| spelling | doaj.art-98d26d128587462a9685e4c1e8d743c92023-10-28T05:09:48ZengElsevierJSES International2666-63832023-11-017624252432Identifying risk factors for 30-day readmission after outpatient total shoulder arthroplasty to aid in patient selectionKenny Ling, MD0Nicholas Tsouris, MD1Alireza Nazemi, MD, MS2David E. Komatsu, PhD3Edward D. Wang, MD4Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USADepartment of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USADepartment of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USADepartment of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USACorresponding author: Edward D. Wang, MD, Department of Orthopaedics, Stony Brook University Hospital, HSC T-18, Room 080, Stony Brook, NY 11794-8181, USA.; Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USABackground: A recent meta-analysis comparing inpatient and outpatient total shoulder arthroplasty (TSA) showed no statistically significant differences in complications, readmissions, revisions, and infections. However, there remains no research on the appropriate patient selection for outpatient TSA surgeries. This retrospective review seeks to aid surgeons in refining a safe patient selection algorithm by evaluating risk factors through a large database analysis of TSA surgeries. Methods: Patients who underwent TSA between 2015 and 2020 were identified in the National Surgical Quality Improvement Program database. Patients with a hospital stay of 0 days were designated as outpatient procedures. Multivariate analyses were used to determine risk factors for 30-day readmission following outpatient TSA and whether risk factors remained significant following overnight hospital stay. Results: A total of 2431 outpatient TSA patients were identified. The incidence of 30-day readmission was 1.8%. The majority of readmissions were due to pulmonary complications. The clinically significant risk factors for 30-day readmission were chronic steroid use (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.34-9.43; P = .011), chronic obstructive pulmonary disease (COPD) (OR 3.11, 95% CI 1.16-8.34; P = .024), and current smoking status (OR 2.27, 95% CI 1.02-5.03; P = .045). After overnight hospital stay, chronic steroid use and current smoking status were not significant, but COPD remained significant. Conclusion: Patients with chronic steroid use, COPD, or current smoking status are at increased risk for 30-day readmission. Inpatient hospital stay appears to benefit patients with chronic steroid use and current smoking status. Patients with COPD should be admitted for inpatient stay postoperatively but may still have high 30-day readmission rates following discharge.http://www.sciencedirect.com/science/article/pii/S2666638323001615Total shoulder arthroplastyReverse shoulder arthroplastyOutpatientReadmissionPatient selectionPostoperative complications |
| spellingShingle | Kenny Ling, MD Nicholas Tsouris, MD Alireza Nazemi, MD, MS David E. Komatsu, PhD Edward D. Wang, MD Identifying risk factors for 30-day readmission after outpatient total shoulder arthroplasty to aid in patient selection JSES International Total shoulder arthroplasty Reverse shoulder arthroplasty Outpatient Readmission Patient selection Postoperative complications |
| title | Identifying risk factors for 30-day readmission after outpatient total shoulder arthroplasty to aid in patient selection |
| title_full | Identifying risk factors for 30-day readmission after outpatient total shoulder arthroplasty to aid in patient selection |
| title_fullStr | Identifying risk factors for 30-day readmission after outpatient total shoulder arthroplasty to aid in patient selection |
| title_full_unstemmed | Identifying risk factors for 30-day readmission after outpatient total shoulder arthroplasty to aid in patient selection |
| title_short | Identifying risk factors for 30-day readmission after outpatient total shoulder arthroplasty to aid in patient selection |
| title_sort | identifying risk factors for 30 day readmission after outpatient total shoulder arthroplasty to aid in patient selection |
| topic | Total shoulder arthroplasty Reverse shoulder arthroplasty Outpatient Readmission Patient selection Postoperative complications |
| url | http://www.sciencedirect.com/science/article/pii/S2666638323001615 |
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