PMID- 33373465
OWN - NLM
STAT- MEDLINE
DCOM- 20210708
LR  - 20210708
IS  - 1938-2367 (Electronic)
IS  - 0147-7447 (Linking)
VI  - 44
IP  - 2
DP  - 2021 Mar-Apr
TI  - The Feasibility of Outpatient Shoulder Arthroplasty: Risk Stratification and 
      Predictive Probability Modeling.
PG  - e215-e222
LID - 10.3928/01477447-20201216-01 [doi]
AB  - Whether shoulder arthroplasty can be performed on an outpatient basis depends on 
      appropriate patient selection. The purpose of this study was to identify risk 
      factors for adverse events (AEs) following shoulder arthroplasty and to generate 
      predictive models to improve patient selection. This was a retrospective review 
      of prospectively collected data using a single institution shoulder arthroplasty 
      registry as well as the American College of Surgeons National Surgical Quality 
      Improvement Program (ACS-NSQIP) database, including subjects undergoing 
      hemiarthroplasty, total shoulder arthroplasty (TSA), and reverse TSA. Predicted 
      probability of suitability for same-day discharge was calculated from 
      multivariable logistic models for different patient subgroups based on age, 
      comorbidities, and Charlson/Deyo Index scores. A total of 2314 shoulders (2079 
      subjects) in the institutional registry met inclusion criteria for this study. 
      Younger age, higher body mass index (BMI), male sex, and prior steroid injection 
      were all significantly associated with suitability for discharge, whereas 
      preoperative narcotic use, comorbidities (heart disease and anemia/other blood 
      disease), and Charlson/Deyo Index score of 2 were associated with AEs that might 
      prevent same-day discharge. Compared with TSA, reverse TSA was associated with 
      less suitability for discharge (P=.01). On querying the ACS-NSQIP database, 
      15,254 patients were identified. Female sex, BMI less than 35 kg/m(2), American 
      Society of Anesthesiologists class III/IV, preoperative anemia, functional 
      dependence, low pre-operative albumin, and hemiarthroplasty were associated with 
      unsuitability for discharge. Males 55 to 59 years old with no comorbidities nor 
      history of narcotic use formed the lowest risk subgroup. Transfusion is the 
      primary driver of AEs. Strategies to avoid this complication should be explored. 
      Risk stratification will improve the ability to identify patients who can safely 
      undergo outpatient shoulder arthroplasty. [Orthopedics. 2021;44(2):e215-e222.].
FAU - Steinhaus, Michael E
AU  - Steinhaus ME
FAU - Liu, Joseph N
AU  - Liu JN
FAU - Gowd, Anirudh K
AU  - Gowd AK
FAU - Chang, Brenda
AU  - Chang B
FAU - Gruskay, Jordan A
AU  - Gruskay JA
FAU - Rauck, Ryan C
AU  - Rauck RC
FAU - YaDeau, Jacques T
AU  - YaDeau JT
FAU - Dines, David M
AU  - Dines DM
FAU - Taylor, Samuel A
AU  - Taylor SA
FAU - Gulotta, Lawrence V
AU  - Gulotta LV
LA  - eng
PT  - Journal Article
DEP - 20201230
PL  - United States
TA  - Orthopedics
JT  - Orthopedics
JID - 7806107
SB  - IM
MH  - Aged
MH  - *Ambulatory Surgical Procedures/adverse effects
MH  - *Arthroplasty, Replacement, Shoulder/adverse effects
MH  - Blood Transfusion
MH  - Body Mass Index
MH  - Comorbidity
MH  - Databases, Factual
MH  - Feasibility Studies
MH  - Female
MH  - Hemiarthroplasty/adverse effects
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/etiology
MH  - Retrospective Studies
MH  - Risk Assessment
EDAT- 2020/12/30 06:00
MHDA- 2021/07/09 06:00
CRDT- 2020/12/29 17:09
PHST- 2020/12/30 06:00 [pubmed]
PHST- 2021/07/09 06:00 [medline]
PHST- 2020/12/29 17:09 [entrez]
AID - 10.3928/01477447-20201216-01 [doi]
PST - ppublish
SO  - Orthopedics. 2021 Mar-Apr;44(2):e215-e222. doi: 10.3928/01477447-20201216-01. 
      Epub 2020 Dec 30.