Trends in Outpatient Shoulder Arthroplasty during the COVID-19 era: Increased Proportion of Outpatient Cases with Decrease in 90-day Readmissions

Abstract

Background The COVID-19 pandemic has placed increased burden on healthcare resources, with hospitals around the globe cancelling or reducing most elective surgical cases during the initial period of the pandemic. Simultaneously, there has been an increased interest in performing outpatient total joint arthroplasty in an efficient manner while maintaining patient safety. The purpose of this study is to investigate trends in total shoulder arthroplasty during the COVID-19 era with respect to outpatient surgery and postoperative complications. Methods After approval from our Institution Review Board (IRB), a retrospective chart review was performed of all primary anatomic and reverse total shoulder arthroplasties at our health institution over a 3 year period (January 2018 – January 2021). All cases done prior to March 2020 were considered the “pre-COVID era” cohort. All cases after March 2020 were in the “COVID-19 era” cohort. Patient demographic and medical comorbidities were also collected to appropriately match patients from the two cohorts. Outcomes measured included patient encounter (outpatient versus inpatient), total length of stay, and 90 day complications. Results A total of 567 total shoulder arthroplasties met the inclusion criteria. There were 270 shoulder arthroplasty cases during the COVID-19 era, and 297 cases during the examined pre-COVID era. There were no significant differences in BMI, ASA score, smoking status, or distribution of pertinent medical comorbidities between the two examined cohorts. During the COVID-19 era, 31.8% of shoulder arthroplasties were performed in the outpatient setting. This was significantly higher than in the pre-COVID era, with only 4.5% of cases done in an outpatient setting (p < 0.0001). Average length of stay was significantly reduced in the COVID-19 era cohort (0.81 versus 1.45 days, p<0.0001). There was a significant decrease in 90-day readmissions during the COVID-19 era. 90 day ER visits, 90 day VTE, or 90 day postoperative infection were not significantly different between the two cohorts. Conclusion We found a significant increase in the number of outpatient shoulder arthroplasty cases being done at our health institution during the COVID-19 era, likely due to a multitude of factors including improved perioperative patient management and increased hospital burden from the COVID-19 pandemic. This increase in outpatient cases was associated with a significant reduction in average hospital length of stay and decrease in 90 day readmissions compared to the pre-COVID era. The data suggest that outpatient total shoulder arthroplasty can be performed in a safe and efficient manner in the appropriate patient cohort.