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

Andrew Carbone; Alexander J Vervaecke; Ivan B Ye; Akshar V Patel; Bradford O Parsons; Leesa M Galatz; Jashvant Poeran; Paul Cagle

doi:10.1016/j.jor.2021.11.016

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.

Authors

Andrew Carbone¹, Alexander J Vervaecke², Ivan B Ye¹, Akshar V Patel¹, Bradford O Parsons¹, Leesa M Galatz¹, Jashvant Poeran³, Paul Cagle¹

Affiliations

¹ Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
² Department of Orthopaedic Surgery, AZ Monica, Antwerp, Belgium.
³ Institute for Healthcare Delivery Science, Department of Population Healthy Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

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.