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.
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.
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.
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).
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.