Outpatient shoulder arthroplasty may be safe for Medicare patients
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Medicare patients may be able to safely undergo outpatient shoulder arthroplasty despite a more severe comorbidity burden, according to results presented at the American Shoulder and Elbow Surgeons Specialty Day Meeting.
Using the Duke-Rush Shoulder Consortium database, Grant E. Garrigues, MD, and colleagues reviewed data on Medicare patients with a short hospital stay after shoulder arthroplasty as a proxy for patients who may be appropriate for outpatient shoulder arthroplasty. Researchers reviewed whether Medicare patients were safe to discharge the same day as surgery, which patients were at higher risk for 90-day readmission and which patients were at higher risk of requiring a skilled nursing facility.
Garrigues noted 13 variables predicted the likelihood that patients could have a same-day discharge, including duration of surgery, age, gender and marital status. He added 11 preoperative variables predicted patients at risk for skilled nursing facility admission, as well as 16 preoperative variables that predicted the likelihood that a patient would have a higher readmission rate after same-day discharge.
Compared with non-Medicare patients, Garrigues noted Medicare patients who had a short stay after surgery did not have a statistically increased risk of 90-day readmission. However, Medicare patients who had a longer hospital stay trended toward statistical significance for higher readmission rate due to a higher percentage of reverse shoulder arthroplasties performed, according to Garrigues.
“If you look by reverse and anatomic and stratify that, the difference completely goes away,” Garrigues said in his presentation. “So, it is based on ... the higher 90-day readmission rate of the reverse total shoulder arthroplasty and the fact that Medicare patients tend to get that procedure at a higher rate.”
Perspective
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Thomas W. (Quin) Throckmorton, MD, FAAOS
Grant E. Garrigues, MD, and colleagues presented a very insightful analysis of more than 5,000 shoulder arthroplasties in an attempt to create a predictive algorithm for postoperative complications and hospital readmissions. This robust database identified several variables that may help the practicing orthopedic surgeon select patients appropriate for same day discharge after shoulder replacement.
Due to many variables, including pressure from payers to deliver value in health care and the on-going COVID-19 pandemic, shoulder surgeons are increasingly transitioning their arthroplasty practices to the outpatient setting. An important consideration is whether the outpatient replacement will be performed in a hospital or ASC. For Medicare patients, CMS has removed total shoulder arthroplasty from the inpatient-only list, which allows same-day discharge from a hospital. However, a reimbursement code has not been assigned as yet for the ASC environment. While this will hopefully follow in the coming months, at the time of this writing, it is important for surgeons to be mindful of medical conditions, payer status and surgical environment when considering outpatient shoulder replacement.
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Garrigues GE. Outpatient shoulder arthroplasty: Appropriate patient selection. Presented at: American Shoulder and Elbow Surgeons Specialty Day Meeting; Feb. 27, 2021 (virtual meeting).
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