These authors searched the National Surgical Quality Improvement Program database between 2005 and 2011 for patients undergoing primary unilateral total shoulder arthroplasty (TSA) for data related to the length of hospital stay. A total of 2004 patients (average age 68.8 years, 57% women) were identified. Mean length of stay after TSA was 2.2 ± 1.7 days. 91% of cases were discharged in less than 3 days.
Renal insufficiency (OR, 11.35; P = .0002), increased age (OR, 2.13; P = .011), longer operative time (OR, 1.94; P = .0041), and American Society of Anesthesiologists class ≥3 (OR, 1.86; P = .0016) were the most significant risk factors for longer length of stay in a multivariate analysis.
Comment: In this case, length of stay was used as the primary outcome variable. Other important outcome variables would have been perhaps more interesting, such as rate of readmission, rate of revision, and functional outcome. This study shows - again - that the health of the patient is an important determinant of the result. Other factors that often have a profound effect are missing from this study, including the specific procedure performed, the experience of the provider, and the problem or diagnosis for which the procedure is performed. Along with patient factors these four form the 4 Ps that determine the quality of the result.
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