ShoulderPreoperative risk factors for discharge to a postacute care facility after shoulder arthroplasty
Section snippets
Materials and methods
A retrospective review of the Nationwide Inpatient Sample (NIS) discharge records was conducted for the years 2011 and 2012. The search was limited to these 2 years because 2011 is the first year a unique billing code was created for reverse total shoulder arthroplasty (RTSA) and 2012 is the final year of data currently available through this database. The NIS is the largest inpatient database in the U.S., representing a sample of discharges from all hospitals participating in the Healthcare
Patient characteristics
In 2011 and 2012, 103,798 patients underwent shoulder arthroplasty procedures: 58,937 had TSA, and 44,893 had a RTSA. The top 3 indications for both procedures were osteoarthritis, rotator cuff arthropathy, and humeral fractures, accounting for 60.3%, 25.1%, and 11.7% of shoulder arthroplasties, respectively. In addition, 1.76% (1827 patients) were revision arthroplasties.
Of all shoulder arthroplasties, 63.5% (65,958 patients) had a routine discharge, and 14.4% (14,908 patients) were discharged
Discussion
Inpatient discharges after surgical procedures often require a multidisciplinary team to optimize patient care. Most patients are discharged home after shoulder arthroplasty, but a minority of patients is transferred to PAC facilities from the inpatient setting. Hip and knee arthroplasty literature has previously identified patients with a high likelihood of requiring a PAC facility; however, no studies have identified patients with a similar risk after shoulder arthroplasty.2, 4, 8, 11, 14
Conclusion
Increasing age, initial presentation with a fracture, female sex, CHF, diabetes, number of comorbidities, and procedure type were identified as risk factors for discharge to a PAC facility. Interestingly, patients undergoing revision surgeries were less likely to be discharged to a PAC facility. These results could be used to preoperatively counsel patients as well as for early discharge planning. Future studies should investigate whether managing preoperative patient expectations regarding
Disclaimer
The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
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2021, JSES InternationalCitation Excerpt :Several patient factors were associated with increased risk of nonhome discharge including female sex, age older than 70 years, ASA classification 3 or greater, and history of diabetes, hypertension, wound infection, steroid use, or a bleeding disorder. Similar associations have been reported in previous studies of TSA and total knee arthroplasty, including a systematic review by Berman et al in which female sex, older age, obesity, and reverse TSA were associated with nonhome discharge.39,40 Hospital discharge after any surgical procedure is a complex process that depends on coordination between numerous parties including the patient, the surgeon, the social worker, the care coordinator, the physical therapist, the nurse, and the hospital administrator.
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This study was exempt from Investigational Review Board review at our institution because it used a publicly disseminated database.