Is There an Association Between Operative Time and Length-of-Stay after Shoulder Arthroplasty?
These authors reviewed data on 14,449 primary shoulder arthroplasty cases found in the National Surgical Quality Improvement Program (NSQIP) database between 2008 and 2016.
Overall, the mean length of stay was 2 ± 2 days. Multivariate analysis showed that after adjusting for patient factors (age, sex, BMI, and ASA, longer operative times were associated with with longer hospital stays.
They pointed to the importance of operating room efficiency on healthcare quality and economics after shoulder arthroplasty. They state, "Hence, based on the results of this study, it seems that surgeons who wish to perform shoulder arthroplasty procedures should strive to become proficient, and dedicate time and effort into decreasing operative time during their TSA and RTSA".
Comment: There is no question that longer surgical times and longer hospital stays lead to increased costs of care. However, the implication of this study is that longer surgery times cause longer lengths of stay, whereas in fact it only showed that longer surgery was associated with longer lengths of stay. It seems likely that more complex cases had both longer operating times and longer hospital stays - unfortunately the study did not stratify cases by diagnosis; thus cases of arthroplasty for fracture were mixed with cases for primary arthritis. It remains to be seen whether, for example, shorter times for anatomic shoulder arthroplasty for osteoarthritis were indeed associated with shorter lengths of stay. This could be addressed simply by plotting OR time vs length of stay for each diagnosis and each procedure type (TSA and RTSA).
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