Distance Travelled is Not Associated with Rate of Same Day Discharge After Primary Total Shoulder Arthroplasty.

Introduction: Cost conservation and value are major components of orthopedic surgery and health economics. One measure frequently used by surgeons to mitigate cost is the utilization of same day discharge (SDD) after total shoulder arthroplasty (TSA). With SDD we must also identify patient factors that support its safety and suitability. The purpose of this study was to investigate if patient travel distance is associated with safe SDD. Secondarily, we aimed to identify other patient factors associated with safe SDD.

Methods: This retrospective review included all patients undergoing primary anatomic or reverse total shoulder arthroplasty by a single surgeon at a single institution between January 2021 to June 2024 in a hospital setting. Patient demographic information, medical comorbidities, surgical factors, and distance in miles to the hospital were collected. Patients were placed into two groups: those discharged the same day as surgery, and those requiring ≥ 1 night hospital stay. Outcomes collected included implant complications, 90-day emergency department utilization, and 90-day readmissions.

Results: 691 patients met inclusion criteria. Of these, 358 were SDD while 333 stayed ≥ 1 night. There was no association between distance traveled and SDD. Patients who were admitted were older (73.12 v 69.14; p < 0.001), more frequently women (63.1% v 44.7%; p < 0.001), less likely to be independent ambulators (70.3 % v 82.4%; p < 0.001), and more likely to live alone (24.6% v 11.7%; p < 0.001). Patients admitted for ≥ 1 night stay were also more likely to have a higher ASA score, have history of diabetes mellitus, hypertension, coronary artery disease, and chronic kidney disease. Of all significant factors, age, female gender, level of assistance at home and ASA III remained significantly associated with hospital admission on multivariate testing. There was no difference between the two groups regarding implant complications, 90-day ED utilization or 90-day readmissions.

Conclusion: The decision for SDD after total shoulder arthroplasty is multifactorial, but is not associated with the distance travelled by the patient to the hospital. Increased age, female gender, use of cane for ambulation and ASA III are independently associated with need for hospital admission after total shoulder arthroplasty. Living with a spouse is independently associated with same day discharge.

Level Of Evidence: Level III; Retrospective Cohort Comparison; Prognosis Study.