Length of stay, discharge disposition, and 90-day emergency department visits and readmissions following primary shoulder arthroplasty in octogenarians vs septuagenarians.

BACKGROUND: The purpose of the current of study was to compare short-term outcomes in primary total shoulder arthroplasty (TSA) patients stratified by age groups of 70-79 years old (septuagenarians) and 80-89 years old (octogenarians).

METHODS: This was a retrospective cohort study at a single academic medical center which included consecutive patients undergoing primary anatomic or reverse TSA (rTSA) over a 5-year period (2014-2019). Peri-operative patient outcomes were collected including length of stay (LOS), discharge location, and 90-day emergency department (ED) visits or readmissions. Multivariable logistic and linear regression analyses were performed to determine whether age group remained independently associated with these outcomes after adjusting for sex, American Society of Anesthesiologists (ASA) score, and procedure type (anatomic versus rTSA).

RESULTS: Overall, 798 patients were included in this study (630 septuagenarians and 168 octogenarians). There was no statistically significant difference in patient race (p = 0.88) or ASA score (p = 0.44) between groups. Octogenarians were more often female (70.8% vs 56.8%; p = 0.001), more often underwent rTSA (61.3% vs 45.2%; p < 0.001), and more often underwent TSA for fracture (13.1% vs 7.1%; p = 0.01). Octogenarians had longer hospital stays (2.8 vs 2.2 days; p < 0.001), less frequently underwent outpatient surgery (1.2% vs 7.1%; p = 0.004), and were more likely to discharge to a skilled nursing facility (SNF)/rehabilitation facility (32.7% vs 12.7%; p < 0.001). On multivariable analysis adjusting for sex, ASA score, and procedure type, octogenarian age group remained independently associated with longer LOS (+0.61 days; p < 0.001) and non-home discharge (adjusted odds ratio [OR] 2.91; 95% confidence interval 1.92-4.41; p < 0.001). There was no statistically significant difference in 90-day ED visit (10.1% vs 7.1%; p = 0.20) or readmission rates (3.6% vs 3.3%; p = 0.88) between groups on either univariable or multivariable analysis.

CONCLUSION: Octogenarians undergoing primary shoulder arthroplasty have similar 90-day post-operative ED visit and readmission rates when compared to their septuagenarian counterparts. However, octogenarians have longer hospital lengths of stay and are more likely to require SNF/rehabilitation at discharge independent of sex, ASA score, and procedure type.

LEVEL OF EVIDENCE: III retrospective comparative study.