Length of Stay in Total Shoulder Arthroplasty: Does Day of Surgery Matter?

Purpose: With health-care utilization becoming an important factor in patient care, we investigated the effect that surgical day of week has on length of hospital stay (LOS) for shoulder arthroplasty patients.Methods: All patients undergoing primary anatomic or reverse total shoulder arthroplasty by a single surgeon on Monday, Wednesday, or Friday over a 10-year period were retrospectively reviewed. A total of 1784 patients met inclusion criteria. Demographics, LOS, and discharge disposition were recorded for all study participants.Results: The overall average LOS was 2.9 ± 1.8 days and was significantly longer for patients having surgery Friday (3.0 ± 1.9 days) versus Wednesday (2.7 ± 1.7 days, P = .002). For those discharged home, the mean LOS was 2.6 ± 1.3 days versus 4.3 ± 3.3 days for those discharged to extended care facilities (ECFs). Patients discharged to ECF with Friday surgery had a significantly longer LOS than Monday ( P = .028) and Wednesday ( P = .010) patients, with 30% of patients with Friday surgery being discharged postoperative day 4 versus 14% and 9% on Monday and Wednesday, respectively. LOS trended toward being longer for Friday surgery in the home disposition group but did not reach significance.Discussion: These results should be considered during surgical scheduling in order to minimize health-care expenditures. Patients at high risk for requiring ECF at discharge should be scheduled at the beginning of the week, while more resources are available to expedite their discharge.

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Preoperative opioid use is an independent risk factor for complication, revision, and increased health care utilization following primary total shoulder arthroplasty

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2020.08.007 ◽

2020 ◽

Author(s):

Jacob M. Wilson ◽

Kevin X. Farley ◽

Michael B. Gottschalk ◽

Charles A. Daly ◽

Eric R. Wagner

Keyword(s):

Health Care ◽

Risk Factor ◽

Health Care Utilization ◽

Shoulder Arthroplasty ◽

Independent Risk Factor ◽

Total Shoulder Arthroplasty ◽

Care Utilization ◽

Opioid Use

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Preoperative depression is a risk factor for complication and increased health care utilization following total shoulder arthroplasty

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2020.04.015 ◽

2021 ◽

Vol 30 (1) ◽

pp. 89-96 ◽

Cited By ~ 2

Author(s):

Matthew P. Lunati ◽

Jacob M. Wilson ◽

Kevin X. Farley ◽

Michael B. Gottschalk ◽

Eric R. Wagner

Keyword(s):

Health Care ◽

Risk Factor ◽

Health Care Utilization ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Care Utilization

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Effects of Increased Retroversion Angle on Glenoid Baseplate Fixation in Reverse Total Shoulder Arthroplasty: A Finite Element Analysis

Seminars in Arthroplasty ◽

10.1053/j.sart.2020.11.014 ◽

2021 ◽

Author(s):

Richard J Friedman ◽

Shuchun Sun ◽

Xin She ◽

Jordan Esposito ◽

Josef Eichinger ◽

...

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Element Analysis ◽

Glenoid Baseplate ◽

Reverse Total Shoulder

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Minimum 2-Year Clinical Outcomes After Superior Capsule Reconstruction Compared with Reverse Total Shoulder Arthroplasty for the Treatment of Irreparable Posterosuperior Rotator Cuff Tears in Patients Younger Than 70 Years Old

10.1055/s-0040-1717567 ◽

2020 ◽

Author(s):

L Lacheta ◽

M Horan ◽

B Goldenberg ◽

G Dornan ◽

PJ Millett

Keyword(s):

Rotator Cuff ◽

Clinical Outcomes ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Rotator Cuff Tears ◽

Superior Capsule Reconstruction ◽

Reverse Total Shoulder

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Special considerations of reverse total shoulder arthroplasty in the treatment of comminuted proximal humeral fractures in elderly: a narrative review

Minerva Ortopedica e Traumatologica ◽

10.23736/s0394-3410.20.03971-5 ◽

2020 ◽

Vol 71 (2) ◽

Author(s):

Dino Bobovec ◽

Tomislav Žigman ◽

Daniel Rajačić ◽

Tomislav Sečan ◽

Tin Ehrenfreund ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Narrative Review ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Reverse Total Shoulder

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Complication and revision rates after reverse total shoulder revision from hemiarthroplasty: a systematic review

Shoulder & Elbow ◽

10.1177/17585732211019390 ◽

2021 ◽

pp. 175857322110193

Author(s):

Arjun K Reddy ◽

Jake X Checketts ◽

B Joshua Stephens ◽

J Michael Anderson ◽

Craig M Cooper ◽

...

Keyword(s):

Systematic Review ◽

Shoulder Arthroplasty ◽

Revisional Surgery ◽

Total Shoulder Arthroplasty ◽

Surgical Site Infections ◽

Total Sample ◽

Reverse Total Shoulder Arthroplasty ◽

Common Complication ◽

Humeral Component ◽

Reverse Total Shoulder

Background Thus, the purpose of the present study was to (1) characterize common postoperative complications and (2) quantify the rates of revision in patients undergoing hemiarthroplasty to reverse total shoulder arthroplasty revisional surgery. We hypothesize that hardware loosenings will be the most common complication to occur in the sample, with the humeral component being the most common loosening. Methods This systematic review adhered to PRISMA reporting guideline. For our inclusion criteria, we included any study that contained intraoperative and/or postoperative complication data, and revision rates on patients who had undergone revision reverse total shoulder arthroplasty due to a failed hemiarthroplasty. Complications include neurologic injury, deep surgical site infections, hardware loosening/prosthetic instability, and postoperative fractures (acromion, glenoid, and humeral fractures). Results The study contained 22 studies that assessed complications from shoulders that had revision reverse total shoulder arthroplasty from a hemiarthroplasty, with a total sample of 925 shoulders. We found that the most common complication to occur was hardware loosenings (5.3%), and of the hardware loosenings, humeral loosenings (3.8%) were the most common. The revision rate was found to be 10.7%. Conclusion This systematic review found that revision reverse total shoulder arthroplasty for failed hemiarthroplasty has a high overall complication and reintervention rates, specifically for hardware loosening and revision rates.

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Assessment of glenoid baseplate initial micromotion and fixation strength in reverse total shoulder arthroplasty designs using a direct shear force methodology

Shoulder & Elbow ◽

10.1177/17585732211032945 ◽

2021 ◽

pp. 175857322110329

Author(s):

Therese E Parr ◽

Jennifer K Anderson ◽

Alan M. Marionneaux ◽

John M Tokish ◽

Stefan J Tolan ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Shear Force ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Fixation Strength ◽

Shoulder Prosthesis ◽

Direct Shear ◽

Device Failure ◽

Glenoid Baseplate ◽

Reverse Total Shoulder

Background In a reverse total shoulder arthroplasty, the altered glenohumeral joint center of rotation subjects the glenoid baseplate to increased shear forces and potential loosening. Methods This study examined glenoid baseplate micromotion and initial fixation strength with the application of direct shear force in a Sawbone model. The reverse total shoulder arthroplasty systems examined were the DJO Reverse® Shoulder Prosthesis, the Exactech Equinoxe® Reverse System, and the Tornier AequalisTM Reverse Shoulder Prosthesis. Specimens were cyclically tested with increasing shear loads until 150 µm of displacement between the implant and glenoid was achieved, and subsequently until failure, classified as either 1 cm of implant/glenoid displacement or fracture. Results The average load withstood for the 150 µm threshold for DJO, Tornier, and Exactech was 460 ± 88 N, 525 ± 100 N, and 585 ± 160 N, respectively. The average total load at device failure for DJO, Tornier, and Exactech was 980 ± 260 N, 1260 ± 120 N, and 1350 ± 230 N, respectively. Discussion The Exactech implant design trended toward requiring more load to induce micromotion at each threshold and to induce device failure, most commonly seen as inferior screw pull out. This study proposes design features that may enhance fixation and suggests little risk of initial micromotion or failure during initial post-operative recovery.

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