Total Shoulder Arthroplasty Postsurgical Complications and Inpatient Versus Outpatient Status

Background: Healthcare systems have pursued safe and cost-effective alternatives to procedures that traditionally require inpatient stays. Total hip and knee arthroplasties have successfully transitioned from Inpatient (IP) to Outpatient (OP) settings. Shoulder Arthroplasty (SA) most recently has transitioned to the outpatient setting as well. To enhance our understanding of the impact of these changes, our study aimed to evaluate postoperative complications for inpatient versus outpatient status in patients undergoing SA to determine if the transition is feasible, safe and efficacious. Methods and Findings: This is a retrospective cohort investigation using the National Surgical Quality Improvement Program (NSQIP) database which was queried for all adults who underwent SA from 2011 to 2016. The primary independent variable was the type of patient status (IP, OP). The dependent variable was postoperative complications within 30 days of surgery. Multivariate logistic regression and propensity score matching were used to determine the association between patient status and postoperative complications while controlling for confounding variables. Of the 13,299 TSA sampled, 94.1% were IP. The IP cohort was significantly older, had a significantly higher proportion of female patients and had significantly higher rates of hypertension. After matching (IP=1,465 patients; OP=81 patients), the frequency of complications was significantly higher in the IP group compared to the OP group (50.8% vs. 34.6%, respectively; p = 0.004). The unadjusted odds ratio of postoperative complications in the entire cohort was significantly higher in the IP than in the OP (OR 1.70, 95% CI 1.16-2.49). The adjusted odds ratio was still statistically significantly higher for the inpatient cohort (aOR 1.53, 95% CI 1.41-2.26). After propensity score matching analysis, the odds ratio was similar (aOR = 1.84, 95% CI 1.14-2.98). Conclusion: Our study provides evidence supporting the safety and efficacy of outpatient TSA compared to the traditional inpatient approach. Our results demonstrated a significant difference in post-op complication rates among the inpatient cohort than the outpatient cohort, with outpatient TSA demonstrating favorable outcomes. These findings demonstrate the importance of appropriately selecting patients for outpatient TSA. Background: Healthcare systems have pursued safe and cost-effective alternatives to procedures that traditionally require inpatient stays. Total hip and knee arthroplasties have successfully transitioned from Inpatient (IP) to Outpatient (OP) settings. Shoulder Arthroplasty (SA) most recently has transitioned to the outpatient setting as well. To enhance our understanding of the impact of these changes, our study aimed to evaluate postoperative complications for inpatient versus outpatient status in patients undergoing SA to determine if the transition is feasible, safe and efficacious. Methods and Findings: This is a retrospective cohort investigation using the National Surgical Quality Improvement Program (NSQIP) database which was queried for all adults who underwent SA from 2011 to 2016. The primary independent variable was the type of patient status (IP, OP). The dependent variable was postoperative complications within 30 days of surgery. Multivariate logistic regression and propensity score matching were used to determine the association between patient status and postoperative complications while controlling for confounding variables. Of the 13,299 TSA sampled, 94.1% were IP. The IP cohort was significantly older, had a significantly higher proportion of female patients and had significantly higher rates of hypertension. After matching (IP=1,465 patients; OP=81 patients), the frequency of complications was significantly higher in the IP group compared to the OP group (50.8% vs. 34.6%, respectively; p = 0.004). The unadjusted odds ratio of postoperative complications in the entire cohort was significantly higher in the IP than in the OP (OR 1.70, 95% CI 1.16-2.49). The adjusted odds ratio was still statistically significantly higher for the inpatient cohort (aOR 1.53, 95% CI 1.41-2.26). After propensity score matching analysis, the odds ratio was similar (aOR = 1.84, 95% CI 1.14-2.98). Conclusion: Our study provides evidence supporting the safety and efficacy of outpatient TSA compared to the traditional inpatient approach. Our results demonstrated a significant difference in post-op complication rates among the inpatient cohort than the outpatient cohort, with outpatient TSA demonstrating favorable outcomes. These findings demonstrate the importance of appropriately selecting patients for outpatient TSA. Keywords: Shoulder Arthroplasty; Postoperative Complications; Inpatient; Outpatient