A Comparison of Patient Same Day Discharge (SDD) Selection Following Shoulder Arthroplasty Before and After the COVID-19 Pandemic.

Introduction: Early discharge has been a target of cost control efforts given the growing demand for joint replacement surgery. Select patients are given the choice for same day discharge (SDD) or overnight stay following shoulder arthroplasty. The COVID-19 pandemic changed patient perspectives regarding hospital visitation and admission. The purpose of this study was to determine if the COVID-19 pandemic impacted the utilization of SDD following shoulder arthroplasty. We hypothesize that patients undergoing shoulder arthroplasty after the start of the COVID-19 pandemic will have higher rates of SDD.

Methods: A retrospective continuous review was performed on 370 patients who underwent a primary anatomic (TSA) or reverse shoulder arthroplasty (RSA) between August 2019 and December 2020 by a single surgeon. This group of patients represent the 185 arthroplasty cases completed before the COVID-19 pandemic, and the first 185 patients after the start of the pandemic. April 1, 2020 was chosen as the cutoff for pre-COVID patients, as this represents the date a statewide ban on elective surgery was declared. All patients were counseled preoperatively regarding SDD and given the choice to stay overnight, unless medically contraindicated. Demographics, medical history, length of stay, 30 and 90-day readmissions, and 90-day emergency room (ER) and urgent care visits were obtained from medical records and compared. Two-tailed student t-tests, chi-square tests, and Fischer's Exact were performed where appropriate.

Results: The two groups were similar in age, BMI, gender distribution, and Outpatient Arthroplasty Risk Assessment (OARA) score. During the collection period, there were more anatomic shoulder arthroplasties performed after (54%) than before (44%) the COVID-19 pandemic (p=0.029). Patients treated after the start of the COVID-19 pandemic were almost 3 times more likely to have a SDD (p<0.001), with 85.4% (158/185) of patients being discharged the same day following COVID-19, compared to 34.6% (64/185) before COVID-19. Discharge Disposition (location of discharge) was significantly different, as 99% (183/185) of patients undergoing surgery after the start of the COVID-19 pandemic were discharged home, compared to 94% (174/185) of patients before COVID-19. There was no difference in 30-day readmissions, 90-day readmissions, and 90-day (ER) and urgent care visits between the two groups.

Conclusion: Our study suggests that the COVID-19 pandemic has dramatically impacted patient choices for SDD within a single surgeon's practice, with nearly 3 times as many patients electing for SDD. Readmissions and ER visits were similar, indicating that SDD remains a safe alternative for patients following TSA and RSA.