Demographic and clinical factors associated with same-day discharge and unplanned readmission following shoulder arthroplasty: a retrospective cohort study

Abstract

Background Same-day discharge, defined as discharge from the hospital within 24 h of surgery, has been shown to be safe for joint arthroplasty. We examined demographic and clinical factors associated with same-day discharge and unplanned readmission following shoulder arthroplasty in adult patients. Methods Utilizing data from the American College of Surgeons National Surgical Quality Improvement Program database, we extracted information of all patients that underwent shoulder arthroplasty. The primary and secondary outcome of interest was same-day discharge and 30-day unplanned readmission, respectively. We utilized multivariable logistic regression to identify covariates associated with these outcomes. Results There were 17,011 patients analyzed when identifying predictors for same-day discharge. There was an increase in same-day discharge from 2007 to 2016. The odds of same-day discharge were significantly better for males (P < 0.001). The odds of same-day discharge was significantly decreased for every 10-year increase in age and for patients with insulin dependent diabetes, poor functional status, chronic obstructive pulmonary disease, congestive heart failure (CHF), bleeding disorder, and comorbidity burden (all P < 0.001). There were 14,276 patients analyzed for hospital readmission. The odds of unplanned readmission were significantly higher for every 10-year increase in age and for patients with poor functional status, CHF, bleeding disorder, and higher comorbidity burden (all P < 0.005). Conclusions The results of this study show that preoperative comorbidities and advanced age reduce the odds of same-day discharge. Risk stratification, preoperative optimization, and coordinated care after surgery may be helpful to optimize patients for same-day discharge.

Keywords

• ambulatory
• discharge planning
• health care quality
• optimization
• outpatient
• rehabilitation