Continued inpatient care after primary total shoulder arthroplasty is associated with increased short-term postdischarge morbidity: A propensity score-adjusted analysis

J. M. Apostolakos
V. Boddapati
M. C. Fu, Northwell Health
B. J. Erickson
D. M. Dines, Zucker School of Medicine at Hofstra/Northwell
L. V. Gulotta
J. S. Dines

Abstract

Copyright © 2019 Slack Incorporated. Advances in surgical technique and implant design during the past several decades have resulted in annual increases in shoulder arthroplasty procedures performed in the United States. The purpose of this investigation was to use the National Surgical Quality Improvement Program database to analyze the rates of morbidity following shoulder arthroplasty. The authors hypothesized that, independent of predischarge patient factors, discharge to inpatient facilities is associated with increased short-term morbidity. Patient demographics, intraoperative variables, and information about postoperative complications/readmissions up to 30 days after the operative event were collected from the National Surgical Quality Improvement Program database for the period 2005 to 2015. Patients were divided into 2 cohorts based on discharge to home vs non-home facilities. Unadjusted baseline patient characteristics were compared using Pearson's chi-square test, and a propensity score-adjusted comparison was also performed. Overall, 9058 patients were included. Of these, 7996 (88.3%) were discharged to home and 1062 (11.7%) were discharged to a non-home facility. On propensity-adjusted analysis, complications determined to be statistically significantly associated with non-home discharge included cardiac (odds ratio, 4.19; 95% confidence interval, 1.75-10.04; P=.001), respiratory (odds ratio, 2.63; 95% confidence interval, 1.47-4.70; P=.001), urinary tract infection (odds ratio, 2.66; 95% confidence interval, 1.52-4.67; P=.001), and death (odds ratio, 7.51; 95% confidence interval, 2.42-23.27; P<.001). Overall, complications were statistically significantly associated with non-home discharges (odds ratio, 2.05; 95% confidence interval, 1.59-2.64; propensity-adjusted P<.001). This investigation indicated an association between postdischarge placement into non-home facilities and an increase in short-term morbidity, regardless of preoperative patient comorbidities.