Is Outpatient Shoulder Arthroplasty Safe in Patients Over 65 Years of Age? A Comparison of Readmissions and Complications in Inpatient and Outpatient Settings.

ABSTRACT: Background Recent studies indicate that outpatient total shoulder arthroplasty (TSA) is cost-effective and may have a low complication rate similar to inpatient TSA. However, existing studies have included younger patient cohorts who typically possess fewer medical comorbidities. Patients older than 65 years are commonly enrolled in Medicare, which has traditionally designated TSA as an inpatient-only procedure. The purpose of this study was to compare surgical complication rates and 90-day readmission rates between inpatient and outpatient TSA performed in adults over the age of 65 years. Methods Medical records for all patients > 65 years of age who underwent primary anatomic or reverse TSA by a single surgeon from July 2015 to May 2020 were reviewed. Patients were preselected for outpatient or inpatient surgery based on lack of significant cardiopulmonary comorbidities and patient preference. Demographics, body mass index (BMI), and American Society of Anesthesiologists (ASA) scores were collected in addition to emergency department (ED) visits and readmissions within 90 days of the index surgery. Relationships among frequency and types of complications and surgical setting (inpatients versus outpatient) were assessed. Complication rates and demographic variables between inpatient and outpatient procedures were compared. Logistic regressions were performed to account for interacting predictor variables on the odds of having complications. Results A total of 145 shoulders (138 patients; 95 male, 43 female) were included in the analysis, of which 98 received inpatient TSA and 47 received outpatient TSA. Average age was 75.5±7.2 for inpatient TSA and 70.5±4.5 for outpatient TSA (p 0.05). Each one-year increase in age increased the predicted odds of having a surgical complication by 14% (OR=1.14; p=0.021), irrespective of surgical setting. Those who underwent inpatient TSA had a significantly higher frequency of 90-day readmission (inpatient=16, outpatient=1; p=0.034). Conclusions Postoperative complications and ED returns were not statistically different between inpatient and outpatient TSA. Each one-year increase in age increased the odds of postoperative surgical complications by 14%, regardless of surgical setting. Outpatient TSA was found to be safe for appropriately selected patients 65 years or older, and re-evaluation of TSA as an inpatient-only procedure should be considered.