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Trends in Outpatient Total Shoulder Arthroplasty Volume Before and After Regulatory Changes: A 10-Year Analysis
Emma Smolev, BA; Kenny Ling, M.D.; Elizabeth Wang, MD; David E. Komatsu, Ph.D.; Edward D. Wang, M.D.
Stony Brook University, Stony Brook, NY
Introduction:
There has been a recent push to perform total shoulder arthroplasty (TSA) in the outpatient setting. There are multiple factors driving the push towards outpatient TSA, including the removal of TSA from the Medicare "Inpatient Only List" (IPO) on January 1, 2021. This change allowed for greater patient access to outpatient TSA for patients on these insurances. The primary objective of this study was to characterize the change in TSA volume stratified by outpatient and inpatient procedures across a 10-year period. The secondary objective was to analyze 30-day complications, readmissions, and reoperations.
Methods:
All patients who underwent total shoulder arthroplasty between 2011 and 2022 were queried from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Postoperative complications were reported within 30 days of procedure. We identified a total of 45,986 patients, and 25.3% (n=11,645) of patients had outpatient surgery. Goodness-of-fit Chi-square test with summary statistics was employed to identify 30-day complications, readmissions, and reoperations between cohorts.
Results:
Of the 45,986 patients who underwent TSA between 2011 and 2022, 74.7% (n=34,341) underwent inpatient TSA, and 25.3% (n=11,645) underwent outpatient TSA. From 2020 to 2022 the volume of inpatient TSA decreased by 50% (3,552 to 1,779) and the volume of outpatient TSA increased by 449% (885 to 4,861). After 2020, patients who underwent TSA were significantly associated with age?75 (p<0.001), male gender (p<0.001), ASA?3 (p<0.001), dependent functional status (p<0.001), and chronic obstructive pulmonary disease (p<0.001). Mean hospital length of stay and operative time decreased for both inpatient and outpatient TSA. Until 2019 inpatient TSA hospital length of stay increased and inpatient operative time trended upward while outpatient operative time trended downward. Home discharge steadily increased for both inpatient and outpatient TSA, until 2020 where outpatient TSA had a sharp increase in home discharge.
Conclusion:
The volume of outpatient TSA increased nearly 5-fold after the removal of TSA from the medicare inpatient-only list on January 1, 2021. Despite expanding eligibility for outpatient TSA, there was no increase in 30-day reoperation, readmission, or major complication.
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