Speaker examines risk for early return to care after same-day shoulder arthroplasty
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SAN DIEGO — Patients who undergo outpatient shoulder arthroplasty with a history of peptic ulcers, psychoses or valvular disease may be at higher risk for return to care within the first 2 postoperative days, according to a presenter.
“Outpatient shoulder arthroplasty can produce similar safety and effectiveness compared with the historical practice of admitting these patients to the hospital, but less is known about returns to care, particularly in the early postoperative period,” Matthew D. McElvany, MD, a shoulder surgeon at Kaiser Permanente in Santa Rosa, California, said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting.
In their cohort study, McElvany and colleagues analyzed data on 2,614 patients who underwent total shoulder arthroplasty (TSA), reverse TSA or hemiarthroplasty and were discharged on the same day. According to the abstract, early return to care was defined as an ED visit or in-hospital readmission within 1, 2 and 7 days of the discharge date. Several patient demographic and clinical factors were evaluated.
Among all patients, 2.8% (n = 74) returned to the ED or were readmitted within 1 day; 4.4% (n = 115) returned to the ED or were readmitted within 2 days; and 8.5% (n = 221) returned to the ED or were readmitted within 7 days.
McElvany and colleagues found patients with a history of peptic ulcer disease or bleeding had a higher likelihood of returning to care within 1 day, while patients with a history of psychoses and valvular disease had a higher likelihood of returning to care within 2 days. Researchers found patients who underwent shoulder arthroplasty at a hospital with a high volume of same-day shoulder arthroplasty procedures were less likely to return to care. No factors included in the study were independently associated with return to care greater than 7 days after surgery.
“As we attempt to figure out who can recover safely at home and who should be admitted, it depends, because if we are using return to care as a surrogate for who might be better off being admitted, those factors we identify will vary significantly depending on the timeframe that you are examining,” McElvany said.
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McElvany MD, et al. Paper 415. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; Aug. 31 - Sept. 3, 2021; San Diego.
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