Secondary Logo

Institutional members access full text with Ovid®

Predicting Discharge Disposition After Shoulder Arthroplasty in the United States

Sivasundaram, Lakshmanan, MD; Tanenbaum, Joseph, PhD; Trivedi, Nikunj, MD; Kim, Chang-Yeon, MD; Bafus, Blaine T., MD; Hoyen, Harry A., MD; Gillespie, Robert J., MD; Wera, Glenn D., MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: May 1, 2019 - Volume 27 - Issue 9 - p e444–e450
doi: 10.5435/JAAOS-D-17-00743
Research Article

Introduction: Postdischarge management for shoulder replacement continues to be performed on a case-by-case basis, with no uniform guidelines dictating management. The goal of this study was to develop a nomogram to preoperatively predict a patient's discharge disposition after elective shoulder arthroplasty.

Methods: Patients who underwent elective shoulder arthroplasty between 2012 and 2015 were identified in the National Surgical Quality Improvement Program database. A multivariable logistic regression model was used to identify risk factors for discharge to a postacute care facility, and these results were used to create a predictive nomogram.

Results: From 2012 to 2015, 8,363 procedures were identified. In our cohort, 962 patients (11.5%) were discharged to a postacute care facility, and 7,492 patients (88.5%) were discharged home. Preoperative functional status, followed by American Society of Anesthesiologists Class and age, had the strongest predictive value for discharge disposition after shoulder arthroplasty.

Discussion: Discharge disposition can be predicted using a nomogram with commonly identified preoperative and intraoperative variables.

Level of Evidence: Level III, retrospective cohort design, observational study

From the University Hospitals of Cleveland (Dr. Sivasundaram, Dr. Tanenbaum, Dr. Trivedi, Dr. Kim, and Dr. Gillespie), Case Western Reserve University, and the MetroHealth Medical Center (Dr. Bafus, Dr. Hoyen, and Dr. Wera), Cleveland, OH.

Correspondence to Dr. Sivasundaram: lakshmanan.sivasundaram@uhhospitals.org

Dr. Bafus or an immediate family member has stock or stock options held in Achaogen. Dr. Hoyen or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of Axogen and DePuy Synthes; serves as a paid consultant to Axogen, Lima, and Stryker; has stock or stock options held in Axogen and Carbofix; and serves as a board member, owner, officer, or committee member of the AO Foundation. Dr. Gillespie or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of DJO Global and serves as a paid consultant to DJO Global and Shoulder Innovations. Dr. Wera or an immediate family member serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Sivasundaram, Mr. Tanenbaum, Dr. Trivedi, and Dr. Kim.

This study was exempt from IRB review at our institution because it uses a publicly disseminated database.

© 2019 by American Academy of Orthopaedic Surgeons
You currently do not have access to this article

To access this article:

Note: If your society membership provides full-access, you may need to login on your society website