Summary

Preoperative Charlson Comorbidity Index, especially a previous history of serious cardiac pathology were significant predictors of 90-day readmission after shoulder arthroplasty.

Abstract

Introduction

The Centers for Medicare and Medicaid Services have established a bundled-payment initiative to link payments for a given episode of care for certain orthopaedic procedures. Similar payment models may be mandated in the near future for shoulder arthroplasty procedures. The purpose of this study was to analyze predictors of 90-day readmission in patients undergoing shoulder arthroplasty.

Methods

This was a single-center retrospective analysis of all primary shoulder arthroplasty procedures performed in patients aged 18 and older from January 1, 2011 to February 1, 2017. Demographics, preoperative American Society of Anaesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), medical history, operative notes, and unplanned readmissions within 90 days of discharge were reviewed. Revision arthroplasty and procedures to treat infections or tumors were excluded.

Results

(no p-values)
A total of 465 patients met inclusion criteria. Readmission within 90 days after hospital discharge occurred in 36 patients (7.8%). Age (64.8 vs 67.2), sex (61.1% vs 53.1% female), body mass index (30.9 vs 31.2 kg/m2) were similar between the readmitted and non-readmitted patients, respectively. Preoperative ASA (2.9 vs 2.7) and CCI (2.1 vs 1.2) scores were significantly greater for the readmitted patients, leading to longer lengths of stay (3.3 vs 2.1 days), compared to non-readmitted patients. Of the CCI components, history of myocardial infarction (MI, 19.4% vs 7.2%) and congestive heart failure (CHF, 19.4% vs 3.5%) were significantly more prevalent in readmitted patients. Multivariate regression analysis demonstrated that age, history of MI, length of stay, and history of CHF were significant independent predictors of 90-day readmission.

Discussion And Conclusion

Preoperative CCI, especially a previous history of serious cardiac pathology (MI, CHF) were significant predictors of 90-day readmission after shoulder arthroplasty. These results underscore the importance of managing patients’ underlying comorbidities to optimize both clinical and financial outcomes in the face of expanding bundled-payment models.