Thursday, July 28, 2016

Will the patient be able to go home after shoulder arthroplasty?

Preoperative risk factors for discharge to a postacute care facility after shoulder arthroplasty.

These authors analyzed the Nationwide Inpatient Sample discharge records from 2011 to 2012 for patients who had a total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA). In 2011 and 2012, 103,798 patients underwent shoulder arthroplasty procedures: 58,937 TSAs and 44,893 RTSAs were identified.

RTSA patients were 1.3 times as likely to be discharged to a post acute care (PAC) facility as TSA patients (P = .001). Medicare patients were 2 times as likely to be discharged to a PAC facility than those with private insurance (P < .001). In addition, women and patients presenting with a fracture, older age, or an increasing number of medical comorbidities were more likely to be discharged to a PAC facility (P < .001).

Comment: In most cases, shoulder arthroplasty is an elective procedure. This means that before surgery we have an opportunity to maximize the health and fitness of the patient. We also have the opportunity to anticipate a non-home discharge for patients at higher risk for this outcome. This gives us the chance to explore the options for PAC disposition, get the patient and family prepared, and assure the funding is in place.

One of the important factors influencing post discharge disposition not mentioned in this report is 'who is at home?' If the patient lives alone or if their housemate is not capable of helping assure their safety for the first few weeks after surgery, a PAC may be necessary. Other important factors not assessed in this study include ambulatory status, mental status, visual acuity and narcotic use.  In our experience these factors are often paramount in the decision making.