ISAKOS: 2019 Congress in Cancun, Mexico
ISAKOS

2019 ISAKOS Biennial Congress ePoster #1911

 

Orthopedic Shoulder Surgery in the Ambulatory Surgical Center: Safety and Outcomes

Charles Qin, MD, Chicago, IL UNITED STATES
Daniel Curtis, MD, Chicago, IL UNITED STATES
Bruce Reider, MD, Rosemont, IL UNITED STATES
Lewis L. Shi, MD, Chicago, IL UNITED STATES
Michael J. Lee, MD
Aravind Athiviraham, MD, Chicago, IL UNITED STATES

University of Chicago, Chicago, IL, UNITED STATES

FDA Status Not Applicable

Summary

Patients undergoing non-arthroplasty shoulder surgery in whom some or all the risk factors for unplanned admission (male, comorbidity burden, open surgery) apply may be more suitable for hospital-based outpatient department as admission from ASC can be more challenging.

Abstract

Background

The shift towards performing orthopaedic surgeries in the outpatient setting and in ambulatory surgical centers (ASC) has been motivated by patient convenience and opportunity for cost-savings for both the patient and the healthcare system. However, it is not known whether the risk of adverse events and readmission following non-arthroplasty surgery is influenced by the outpatient setting of surgical care.

Methods

The Humana Claims Database was queried for all patients undergoing orthopedic shoulder surgery in the hospital-based outpatient department (HOPD) or ambulatory surgical center (ASC) setting, using the PearlDiver supercomputer(PearlDiver Technologies, Colorado Springs, Colorado). Arthroplasty procedures were excluded because they carry a risk profile different from those of other outpatient surgeries. Outcome variables included unanticipated admission following surgery, readmission, deep vein thrombosis (DVT), pulmonary embolism (PE), and wound infection within 90 days of surgery. The ASC and HOPD cohorts were propensity score matched and outcomes compared between them. Finally, logistic regression models were created to identify risk factors associated with unplanned admission following surgery.

Results

84,658 patients met inclusion criteria for our study, 28,730 in the ASC cohort and 56,819 in the HOPD cohort. Rates of all queried outcomes were greater in the HOPD cohort, and met statistical significance. Upon logistic regression, factors associated with unplanned admission included increasing Charlson comorbidity index (1.16, 1.12- 1.17, p<.001), HOPD service location (2.37, 2.18-2.58, p<.001), general anesthesia (1.34, 1.08-1.59, p=.008), male gender (2.58, 2.17-3.15, p=.007), and open surgery (2.35, 1.90-2.61, p<.001).

Discussion

The lower rates of peri-operative morbidity in the ASC cohort suggest that proper patient selection is taking place and lends reassurance to surgeons who are or are considering practicing in an ASC. Patients in whom some or all the risk factors for unplanned admission (male, comorbidity burden, open surgery) apply may be more suitable for HOPDs as admission from an ASC can be difficult and potentially unsafe.