Predictors of Return to Emergency Department and Readmission Following Primary Elective Total Shoulder Arthroplasty

Objectives: Returns to the Emergency Department (ED) and unplanned readmissions within ۹۰ days of shoulder arthroplasty represent a significant financial burden to healthcare systems. Identifying the reasons and risk factors could potentially reduce their prevalence. Methods: A retrospective review of primary anatomic (aTSA) and reverse shoulder arthroplasty (rTSA) cases from January ۲۰۱۶ through August ۲۰۲۳ was performed. Demographic patient and surgical data, including age, diagnosis of anxiety or depression, body mass index (BMI), smoking status, age-adjusted Charlson Comorbidity Index (ACCI), modified ۵-item fragility index (mFI-۵), and hospital length of stay (LOS) was collected. Patient visits to the ED within ۱۲ months prior to surgery were recorded. Predictors for return to the ED within ۹۰ days postoperatively and any readmissions were determined. Results: There were ۳۳۸ cases (۱۶۷ aTSA and ۱۷۱ rTSA), of which ۲۲۵ (۶۷%) were women. Patients with anxiety (OR=۲.۴۴, ۹۵% CI ۱.۱۱–۵.۳۳; P=۰.۰۲۶), surgical postoperative complications (OR=۳.۲۲, ۹۵% CI ۱.۳۶–۷.۵۸; P=۰.۰۰۸), ED visit within ۳ months prior to surgery (OR=۳.۸۰, ۹۵% CI ۱.۷۱–۸.۴۵; P=۰.۰۰۱), ED visit ۳ to ۶ months prior to surgery (OR=۲.۶۰, ۹۵% CI ۱.۱۲–۶.۰۵; P=۰.۰۲۷), and ED visit ۶ to ۱۲ months prior to surgery (OR=۲.۱۲, ۹۵% CI ۱.۰۲–۴.۴۱; P=۰.۰۴۵) were more likely to have ED visit within ۹۰ days postoperatively. Patients with prior ipsilateral shoulder surgery (OR=۳.۳۲, ۹۵% CI ۱.۲۱–۹.۰۹; P=۰.۰۲), surgical postoperative complications (OR=۱۳.۹۲, ۹۵% CI ۵.۰۴–۳۸.۴۲; P<۰.۰۰۱), an ED visit within ۳ to ۶ months preoperatively (OR=۸.۴۷, ۹۵% CI ۲.۸۴–۲۵.۲۷; P<۰.۰۰۱), and an mFI-۵ ≥۲ (OR=۳.۶۶, ۹۵% CI ۱.۳۵–۹.۹۱; P=۰.۰۱۱) were more likely to be readmitted within ۹۰ days. Conclusion: Patients who present to the ED within ۱۲ months prior to shoulder arthroplasty, those with anxiety, those with surgical complications and those with higher fragility should be monitored closely during the early postoperative period to minimize returns to the ED and/or unplanned readmissions.  Level of evidence: III

کلیدواژه ها:

۹۰-day readmission ، modified fragility index ، return to emergency department ، Risk factors