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

Abstract

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.