Outpatient versus inpatient total shoulder arthroplasty: A cost and outcome comparison in a comorbidity matched analysis

J Orthop. 2021 Dec 1;28:126-133. doi: 10.1016/j.jor.2021.11.016. eCollection 2021 Nov-Dec.

Abstract

Background: Previous studies comparing total and reverse shoulder arthroplasty (TSA/RSA) are subject to surgeon selection bias. This study objective is to compare the outcomes and cost of outpatient TSA/RSA to inpatient TSA/RSA.

Methods: 108,889 elective inpatient and outpatient TSA/RSA from Medicare claims data (2016-2018). 90-day readmission and total 90-day costs were compared following propensity score matching.

Results: Younger and healthier patients are receiving outpatient TSA/RSA. Outpatient TSA/RSA was associated with fewer 90-day readmissions (OR 0.48 CI 0.38-0.59, p < 0.001) and lower 90-day costs (-20.1% CI -19.1%; -21.1%, p < 0.001).

Conclusions: Outpatient TSA/RSA surgery offers lower complication rates and total costs.

Level of evidence: III.

Keywords: Ambulatory surgery center; Cost analysis; Outpatient; Readmission; Reverse shoulder arthroplasty; Total shoulder arthroplasty.