Determining the Validity of the Outpatient Arthroplasty Risk Assessment Tool (OARA) for Identifying Patients for Safe Same-Day Discharge after Primary Shoulder Arthroplasty.

Introduction Early discharge has been a target of cost control efforts given the growing demand for joint replacement surgery. A medically based risk assessment score known as Outpatient Arthroplasty Risk Assessment (OARA) has shown high predictive ability in achieving safe early discharge following outpatient lower extremity arthroplasty utilizing a score threshold initially set at ≤59, but more recently adapted to ≤79. However, there has been no study utilizing OARA for shoulder replacements, which has been shown to have lower associated medical risks than lower extremity arthroplasty. The purpose of this study is to determine the OARA score threshold for same day discharge (SDD) following shoulder arthroplasty and evaluate its effectiveness in selecting patients for SDD. We hypothesize that the OARA threshold for shoulder arthroplasty will be higher than for lower extremity arthroplasty. Methods A retrospective review was performed on 422 patients who underwent a primary anatomic or reverse shoulder arthroplasty between April 2018-October 2019 by a single surgeon. As standard practice, all patients were counseled preoperatively regarding SDD and given the choice to stay overnight. Medical history, length of stay, and 90-day readmissions were obtained from medical records. Analysis of variance (ANOVA) testing and screening test characteristics compared OARA score performance with American Society of Anesthesiologists Physical Status (ASA-PS) and a previously published OARA threshold used to define low risk for outpatient lower extremity arthroplasty. Results A preoperative OARA score cutoff of ≤110 points demonstrated a sensitivity of 98.0% for identifying patients who SDD after shoulder arthroplasty, compared to 66.7% using the hip and knee OARA threshold of ≤59 points (p 110. There was no difference in 30-day and 90-day readmission rates for patients with OARA scores ≤59, ≤110, and ASA-PS ≤2. Conclusion Our study suggests a preoperative OARA threshold of ≤110 is effective and conservative in screening patients for SDD following shoulder arthroplasty, with low rates of 90-day emergency room visits and readmissions. This threshold is a useful screening tool to identify patients that are not good candidates for SDD. Level of evidence Basic Science Study; Validation of Classification System