Trends and outcomes of outpatient total shoulder arthroplasty after its removal from CMS's inpatient-only list

In January 2021, the US Medicare program approved reimbursement of outpatient total shoulder arthroplasties (TSA), including anatomic and reverse TSAs. It remains unclear whether shifting TSAs from the inpatient to outpatient setting has affected clinical outcomes. Herein, we describe the rate of ou...

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Bibliographic Details
Published in:Journal of shoulder and elbow surgery 2024-04, Vol.33 (4), p.841-849
Main Authors: O'Donnell, Evan A., Best, Matthew J., Simon, Jason E., Liu, Harry, Zhang, Xiaoran, Armstrong, April D., Warner, Jon J.P., Khan, Adam Z., Fedorka, Catherine J., Gottschalk, Michael B., Kirsch, Jacob, Costouros, John G., Fares, Mohamad Y., Beck da Silva Etges, Ana Paula, Srikumaran, Uma, Wagner, Eric R., Jones, Porter, Haas, Derek A., Abboud, Joseph A.
Format: Article
Language:English
Subjects:
Aged
Arthroplasty, Replacement, Shoulder - adverse effects
Centers for Medicare and Medicaid Services, U.S
hospital readmission
Humans
Inpatients
Medicare
mortality
outpatient
Outpatients
Pandemics
patient outcomes
Patient Readmission
postoperative complication
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Retrospective Studies
Total shoulder arthroplasty
United States - epidemiology
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Summary:In January 2021, the US Medicare program approved reimbursement of outpatient total shoulder arthroplasties (TSA), including anatomic and reverse TSAs. It remains unclear whether shifting TSAs from the inpatient to outpatient setting has affected clinical outcomes. Herein, we describe the rate of outpatient TSA growth and compare inpatient and outpatient TSA complications, readmissions, and mortality. Medicare fee-for-service claims for 2019-2022Q1 were analyzed to identify the trends in outpatient TSAs and to compare 90-day postoperative complications, all-cause hospital readmissions, and mortality between outpatients and inpatients. Outpatient cases were defined as those discharged on the same day of the surgery. To reduce the COVID-19 pandemic's impact and selection bias, we excluded 2020Q2-Q4 data and used propensity scores to match 2021-2022Q1 outpatients with inpatients from the same period (the primary analysis) and from 2019-2020Q1 (the secondary analysis), respectively. We performed both propensity score-matched and -weighted multivariate analyses to compare outcomes between the two groups. Covariates included sociodemographics, preoperative diagnosis, comorbid conditions, the Hierarchical Condition Category risk score, prior year hospital/skilled nursing home admissions, annual surgeon volume, and hospital characteristics. Nationally, the proportion of outpatient TSAs increased from 3% (619) in 2019Q1 to 22% (3456) in 2021Q1 and 38% (6778) in 2022Q1. A total of 55,166 cases were identified for the primary analysis (14,540 outpatients and 40,576 inpatients). Overall, glenohumeral osteoarthritis was the most common indication for surgery (70.8%), followed by rotator cuff pathology (14.6%). The unadjusted rates of complications (1.3 vs 2.4%, P 
ISSN:1058-2746
1532-6500
DOI:10.1016/j.jse.2023.07.019