These authors investigated the effect that surgical day of week has on length of hospital stay (LOS) for shoulder arthroplasty patients.
1784 patients had a primary anatomic or reverse total shoulder arthroplasty by a single surgeon on Monday, Wednesday, or Friday over a 10-year period, were retrospectively reviewed.
The overall average LOS was 2.9±1.8 days and was significantly longer for patients having surgery Friday (3.0±1.9 days) versus Wednesday (2.7±1.7 days, P..002). For those discharged home, the mean LOS was 2.6±1.3 days versus 4.3±3.3 days for those discharged to extended care facilities (ECFs). Patients discharged to ECF with Friday surgery had a significantly longer LOS than Monday (P..028) and Wednesday (P..010) patients, with 30% of patients with Friday surgery being discharged postoperative day 4 versus 14% and 9% on Monday and Wednesday, respectively.
Comment: We have implemented a system-wide program designed to discharge patients to home on the day after surgery. This program is based on (1) setting the expectation of next day discharge well before the procedure (2) assuring that the patient has a family member or friend as their Care Partner, who will be readily available for the 1st seven days after discharge, (3) reinforcing that shoulder joint replacement does not meet the criteria for admission to an ECF, (4) assuring the patient that after surgery they will have ready access to their surgical team via email and phone, (5) use of preoperative tylenol, celebrex and neurontin, (6) transitioning the patient to oral pain medication on the afternoon of surgery and (7) avoiding the use of brachial plexus blocks.
At present, the majority of our patients are discharged the day after surgery, avoiding the "day of the week" problem identified in the study.
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