Non-Home Discharge is an Independent Risk Factor for Readmission Following Primary Total Shoulder Arthroplasty.

Introduction: Utilization of total shoulder arthroplasty (TSA) in the United States has increased substantially within the last two decades and this trend is expected to continue. As TSA volume has continued to increase, healthcare policy has shifted towards an emphasis on value-based care. Therefore, it is important to understand variables that may increase TSA costs, including readmission rates. Patients discharged to home healthcare (HHC) or post-acute care (PAC) facilities have demonstrated increased readmission rates following TSA. However, few studies have directly compared HHC to PAC facilities and routine home discharge while accounting for pertinent demographics. The purpose of this study was to compare 180-day readmission rates between routine home discharge, HHC, and PAC facility groups following primary TSA.

Methods: The Nationwide Readmissions Database was queried from 2010 to 2020 to identify all patients that underwent primary TSA. Readmission rates were compared between routine home discharge, HHC, and PAC facility groups. Binary logistic regression identified independent risk factors for readmission within 180 days.

Results: From 2010 to 2020 a total of 171,898 patients underwent TSA. 71% were routinely discharged home, 21% were discharged to HHC, and 8% were discharged to a PAC facility. After adjusting for income, insurance, obesity status, age, Charlson Comorbidity index, and gender, discharge to a PAC facility was independently predictive of readmission within 180 days following TSA (OR: 1.69, 95% CI 1.59-1.79, p<0.001).

Conclusion: Patients discharged to a PAC facility after TSA had higher readmission rates compared to HHC and routine home discharge that persisted even after controlling for relevant demographics. Clinicians should be cognizant of the risks and benefits of different discharge methods and consider home discharges for suitable candidates. Understanding risk factors that increase healthcare expenditures has significant utility for institutions in the era of bundled care. However, it is important that alternative payment models do not disincentivize orthopedic surgeons from providing care to medically complex patients.