Outpatient total shoulder arthroplasty: a population-based study comparing adverse event and readmission rates to inpatient total shoulder arthroplasty

Aims Few studies have compared survivorship of total shoulder arthroplasty (TSA) with hemiarthroplasty (HA). This observational study compared survivorship of TSA with HA while controlling for important covariables and accounting for death as a competing risk. Patients and Methods All patients who underwent shoulder arthroplasty in Ontario, Canada between April 2002 and March 2012 were identified using population-based health administrative data. We used the Fine–Gray sub-distribution hazard model to measure the association of arthroplasty type with time to revision surgery (accounting for death as a competing risk) controlling for age, gender, Charlson Comorbidity Index, income quintile, diagnosis, and surgeon factors. Results During the study period, 5777 patients underwent shoulder arthroplasty (4079 TSA, 70.6%; 1698 HA, 29.4%), 321 (5.6%) underwent revision, and 1090 (18.9%) died. TSA patients were older (TSA mean age 68.4 years (sd 10.2) vs HA mean age 66.5 years (sd 12.7); p = 0.001). The proportion of female patients was slightly lower in the TSA group (58.0% vs 58.4%). The adjusted association between surgery type and time to shoulder revision interacted significantly with patient age. Compared with TSA patients, revision was more common in the HA group (adjusted-health ratio (HR) 1.214, 95% confidence interval (CI) 0.96 to 1.53) but this did not reach statistical significance. Conclusion Although there was a trend towards higher revision risk in patients undergoing HA, we found no statistically significant difference in survivorship between patients undergoing TSA or HA. Cite this article: Bone Joint J 2019;101-B:454–460.

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Shoulder Arthroplasty in Patients with Rheumatoid Arthritis: A Population-Based Study Examining Utilization, Adverse Events, Length of Stay, and Cost

The American Journal of Orthopedics ◽

10.12788/ajo.2018.0046 ◽

2018 ◽

Vol 47 (6) ◽

Author(s):

Timothy S. Leroux ◽

Bryce A. Basques ◽

Bryan M. Saltzman ◽

Gregory P. Nicholson ◽

Anthony A. Romeo ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Length Of Stay ◽

Adverse Events ◽

Shoulder Arthroplasty ◽

Population Based ◽

Population Based Study

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Psychiatrists' caseload volume, length of stay and mental healthcare readmission rates: A three-year population-based study

Psychiatry Research ◽

10.1016/j.psychres.2007.11.011 ◽

2009 ◽

Vol 166 (1) ◽

pp. 15-23 ◽

Cited By ~ 11

Author(s):

Herng-Ching Lin ◽

Hsin-Chien Lee

Keyword(s):

Length Of Stay ◽

Mental Healthcare ◽

Population Based ◽

Readmission Rates ◽

Population Based Study

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The association between readmission rates and length of stay for schizophrenia: A 3-year population-based study

Schizophrenia Research ◽

10.1016/j.schres.2006.01.012 ◽

2006 ◽

Vol 83 (2-3) ◽

pp. 211-214 ◽

Cited By ~ 37

Author(s):

Herng-Ching Lin ◽

Wei-Hua Tian ◽

Chin-Shyan Chen ◽

Tsai-Ching Liu ◽

Shang-Ying Tsai ◽

...

Keyword(s):

Length Of Stay ◽

Population Based ◽

Readmission Rates ◽

Population Based Study

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Trends in New South Wales infant hospital readmission rates in the first year of life: a population‐based study

The Medical Journal of Australia ◽

10.5694/mja13.11288 ◽

2014 ◽

Vol 201 (1) ◽

pp. 40-43 ◽

Cited By ~ 6

Author(s):

Samantha J Lain ◽

Christine L Roberts ◽

Jennifer R Bowen ◽

Natasha Nassar

Keyword(s):

Hospital Readmission ◽

New South ◽

New South Wales ◽

Population Based ◽

First Year ◽

Readmission Rates ◽

Population Based Study ◽

Hospital Readmission Rates ◽

South Wales ◽

First Year Of Life

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The safety of outpatient total shoulder arthroplasty: a systematic review and meta-analysis

International Orthopaedics ◽

10.1007/s00264-021-04940-7 ◽

2021 ◽

Vol 45 (3) ◽

pp. 697-710

Author(s):

Abdulaziz F. Ahmed ◽

Ashraf Hantouly ◽

Ammar Toubasi ◽

Osama Alzobi ◽

Shady Mahmoud ◽

...

Keyword(s):

Systematic Review ◽

Shoulder Arthroplasty ◽

Outpatient Surgery ◽

Financial Burden ◽

Meta Analysis ◽

Total Shoulder Arthroplasty ◽

Primary Objective ◽

Readmission Rates ◽

Admission Rates ◽

Data Source

Abstract Purpose To meet the increasing demands of total shoulder arthroplasty (TSA) while reducing its financial burden, there has been a shift toward outpatient surgery. This systematic review and meta-analysis aimed to evaluate the safety of outpatient TSA. Methods The primary objective was to compare re-admission rates and postoperative complications in outpatient versus inpatient TSA. The secondary objectives were functional outcomes and costs. PubMed, Google Scholar, and Web of Science were searched until March 28, 2020. The inclusion criteria were studies reporting at least complications or readmission rates within a period of 30 days or more. Results Ten level III retrospective studies were included with 7637 (3.8%) and 192,025 (96.2%) patients underwent outpatient and inpatient TSA, respectively. Outpatient TSA had relatively younger and healthier patients. There were no differences between outpatient and inpatient arthroplasty for 30- and 90-day readmissions. Furthermore, unadjusted comparisons demonstrated significantly less total and major surgical complications, less total, major, and minor medical complications in favour of outpatient TSA. However, subgroup analyses demonstrated that there were no significant differences in all complication if the studies had matched controls and regardless of data source (database or nondatabase studies). The revision rates were similar between both groups at a 12–24 months follow-up. Two studies reported a significant reduction in costs in favour of outpatient TSA. Conclusion This study highlights that outpatient TSA could be a safe and effective alternative to inpatient TSA in appropriately selected patients. It was evident that outpatient TSA does not lead to increased readmissions, complications, or revision rates. A potential additional benefit of outpatient TSA was cost reduction.

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Ninety-Day Readmission Following Shoulder Arthroplasty

Journal of Shoulder and Elbow Arthroplasty ◽

10.1177/2471549218810016 ◽

2018 ◽

Vol 2 ◽

pp. 247154921881001 ◽

Cited By ~ 1

Author(s):

Manisha R Chand ◽

Arjun Meiyappan ◽

Jesus M Villa ◽

Sumit Kanwar ◽

Vani J Sabesan ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Hospital Readmissions ◽

Patient Characteristics ◽

Previous Surgery ◽

Readmission Rates ◽

Vein Thrombosis ◽

The One ◽

Deep Vein

Introduction Hospital readmissions after elective shoulder arthroplasty represent a costly burden to the health-care system due to the rising demand for this procedure. Nevertheless, the reasons for readmissions remain inconclusive. Therefore, the main purposes of the current investigation were to determine (1) the readmission rates within 90 days after shoulder arthroplasty, (2) the reasons behind those readmissions, and (3) the characteristics of readmitted patients. Methods A retrospective review was performed on 184 patients who underwent total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA) performed by a single surgeon at a single institution between 2010 and 2016. The readmissions that occurred within 90 days after surgery and their reasons were noted. Patient characteristics were compared between readmitted and non-readmitted patients. Results Overall, 7.1% of patients were readmitted within 90 days after shoulder arthroplasty. However, patients with a previous surgery on the same shoulder of the TSA or RSA had a higher rate (13.5%) than patients without a previous surgery (5.4%). Readmission rates for TSA and RSA were virtually identical. Most readmissions were due to surgical (69.2%) rather than medical complications (30.8%). The most common reasons for readmission were surgical-site infection and deep vein thrombosis. There were no statistically significant differences between the baseline patient characteristics of readmitted and non-readmitted patients. However, the proportion of males (69.2%) was more than twice the one of females (30.8%) among readmitted patients. Conclusion The readmission rate within 90 days after surgery was relatively low among patients who underwent either a TSA or RSA at our institution. Surgically related causes were largely responsible for readmissions.

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A Point-Based Model to Predict Absolute Risk of Revision in Anatomic Shoulder Arthroplasty

Journal of Shoulder and Elbow Arthroplasty ◽

10.1177/2471549219883446 ◽

2019 ◽

Vol 3 ◽

pp. 247154921988344

Author(s):

Peter LC Lapner ◽

Meaghan D Rollins ◽

Meltem G Tuna ◽

Caleb Netting ◽

Anan Bader Eddeen ◽

...

Keyword(s):

Risk Score ◽

Shoulder Arthroplasty ◽

Absolute Risk ◽

Total Shoulder Arthroplasty ◽

Population Based ◽

Income Quintile ◽

Test Statistic ◽

Revision Risk ◽

Functional Outcome Measures ◽

Arthroplasty Revision

Background Total shoulder arthroplasty (TSA) has demonstrated good long-term survivorship but early implant failure can occur. This study identified factors associated with shoulder arthroplasty revision and constructed a risk score for revision surgery following shoulder arthroplasty. Methods A validated algorithm was used to identify all patients who underwent anatomic TSA between 2002 and 2012 using population-based data. Demographic variables included shoulder implant type, age and sex, Charlson comorbidity score, income quintile, diagnosis, and surgeon arthroplasty volume. The associations of covariates with time to revision were measured while treating death as a competing risk and were expressed in the Shoulder Arthroplasty Revision Risk Score (SARRS). Results During the study period, 4079 patients underwent TSA. Revision risk decreased in a nonlinear fashion as patients aged and in the absence of osteoarthritis with no influence from surgery type or other covariables. The SARRS ranged from −21 points (5-year revision risk 0.75%) to 30 points (risk 11.4%). Score discrimination was relatively weak 0.55 (95% confidence interval: 0.530.61) but calibration was very good with a test statistic of 5.77 ( df = 8, P = .762). Discussion The SARRS model accurately predicted the 5-year revision risk in patients undergoing TSA. Validation studies are required before this score can be used clinically to predict revision risk. Further study is needed to determine if the addition of detailed clinical data including functional outcome measures and the severity of glenohumeral arthrosis increases the model’s discrimination.

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