Factors Affecting Length of Stay, Readmission, and Revision After Shoulder Arthroplasty
Update This article was updated on August 6, 2015, because of previous errors. Two footnotes in Table II were incorrectly ordered and one table entry had the incorrect footnote symbol. The footnotes had previously read as: “†Cutpoints defining the five categories for facility volume and surgeon volume are the 10th, 50th, 75th, and 90th percentiles of the counts of procedures in the year prior to the index arthroplasty. This approach was chosen as a practical strategy for a categorical parameterization of likely nonlinear relationships of these factors with the three outcomes. ‡The indicators for the diagnoses and the specific comorbidities do not define mutually exclusive categories as patients can have multiple diagnoses and comorbidities. All of the other categorical factors in this table (sex, age, race, insurance type, Charlson Comorbidity Index, facility and surgeon case volumes) are coded with mutually exclusive levels.” The footnotes now read as: “†The indicators for the diagnoses and the specific comorbidities do not define mutually exclusive categories as patients can have multiple diagnoses and comorbidities. All of the other categorical factors in this table (sex, age, race, insurance type, Charlson Comorbidity Index, facility and surgeon case volumes) are coded with mutually exclusive levels. ‡Cutpoints defining the five categories for facility volume and surgeon volume are the 10th, 50th, 75th, and 90th percentiles of the counts of procedures in the year prior to the index arthroplasty. This approach was chosen as a practical strategy for a categorical parameterization of likely nonlinear relationships of these factors with the three outcomes.” Also, the incorrect footnote symbol appeared in the table entry “Specific comorbidities‡”. It now reads as “Specific comorbidities†”. An erratum has been published: J Bone Joint Surg Am. 2015 Sep 2;97(17):e60. Background: Increased length of hospital stay, hospital readmission, and revision surgery are adverse outcomes that increase the cost of elective orthopaedic procedures, such as shoulder arthroplasty. Awareness of the factors related to these adverse outcomes will help surgeons and medical centers design strategies for minimizing their occurrence and for managing their associated costs. Methods: We analyzed data from the New York Statewide Planning and Research Cooperative System on 17,311 primary shoulder arthroplasties performed from 1998 to 2011 to identify factors associated with extended lengths of hospitalization after surgery, readmission within ninety days, and surgical revision. Results: The factors associated with each of these three adverse outcomes were different. Longer lengths of hospital stay were associated with female sex, advanced patient age, Medicaid insurance, comorbidities, fracture as the diagnosis for arthroplasty, higher hospital case volumes, and lower surgeon case volumes. Readmission was associated with advanced patient age and medical comorbidities. The most common diagnoses for readmission within ninety days were fluid and electrolyte imbalance (28%), acute pulmonary problems (21%), cardiac arrhythmia (20%), heart failure (15%), acute myocardial infarction (10%), and urinary tract infection (10%). Revision was associated with younger patient age and osteoarthritis or traumatic arthritis. The most common diagnoses at the time of revision surgery were unspecified mechanical complications of the implant (60%), shoulder pain (18%), dislocation of the prosthetic joint (12%), component loosening (10%), a broken prosthesis (8%), a cuff tear (7%), and infection (7%). Conclusions: A small number of easily identified characteristics (sex, age, race, insurance type, comorbidities, diagnosis, and provider case volumes) were significantly associated with longer lengths of stay, readmission, and revision surgery. Consideration of these factors and their effects may guide efforts to improve patient safety and to manage the costs associated with these adverse outcomes. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.