Outpatient shoulder surgery at hospital-based departments linked with more unplanned readmissions vs ASC setting

LAS VEGAS — Researchers concluded from their analysis of nonarthroplasty shoulder surgery from cases in an administrative claims database that procedures that involved men, open surgery or patients with a higher comorbidity burden should probably be performed at a hospital-based outpatient department rather than an ASC, based on adverse events reported.

They found consistently lower rates of factors associated with perioperative morbidity among patients whose shoulder surgery was performed at an ASC, according to a presentation by Charles D. Qin, MD, at the American Academy of Orthopaedic Surgeons Annual Meeting.

According to Qin and his colleagues, surgery at a hospital-based outpatient department (HOPD) may be better for patients with factors they identified as being associated with unplanned admission after shoulder surgery, including male sex and open surgery because, as they noted in their study, “admission from an ASC can be difficult and potentially unsafe.”

“The HOPD surgical setting was associated with a greater than double likelihood of unplanned readmission following outpatient shoulder surgery,” Qin said in his presentation.

“Rates of all outcomes were statistically greater in the HOPD group compared to the ASC group in both the pre- and post-matched analysis. Rates of all unplanned admission following surgery was 0.5% in the HOPD group compared to 0.2% in the ASC group,” Qin said.

To eliminate selection bias in the study, Qin and colleagues used propensity scoring to match the patients who underwent surgery at an ASC or HOPD to allow comparing the two groups’ outcome variables, which included unanticipated admission after surgery, readmission events, deep vein thrombosis, pulmonary embolism and wound infection that occurred within 90 days postoperatively, he said.

Results showed 90-day readmission rates were 3.7% in the HOPD group compared to 3% in the ASC group.

“In summary, the lower rates of perioperative morbidity seen in the ASC group in the pre-matched data suggest that proper patient selection is taking place,” Qin said, noting rates of medical complications in either group were less than 1%. – by Susan M. Rapp

Reference:

Qin CD, et al. Abstract 451. Presented at: American Academy of Orthopaedic Surgeons; March 12-16, 2019; Las Vegas.

Disclosure: Qin reports no relevant financial disclosures.