Annual Hospital Surgical Volume and Patient Medical Complexity Affect Length of Stay for rTSA but not Overall Risk of Complications Following TSA, rTSA and Revision TSA.

Abstract

Total shoulder arthroplasty (TSA) volume has significantly increased over the last several decades, especially in the outpatient setting. Performing TSA in lower volume hospital facilities may offset demand, especially when treating medically complex patients. The purpose of this study is to assess the association of annual hospital volume and patient medical complexity with postoperative complications, readmissions, and length of stay in patients undergoing TSA, rTSA, and revision TSA. The 2016-2022 Statewide Planning and Research Cooperative System Database (an all-payer dataset within New York State) was used to query demographic information, procedure type, outcomes/complications, and length of stay (LOS) for patients who underwent the above procedures. Hospital volume was divided into quartiles, with quartile four the highest performing. Multivariable logistic regression was performed to determine the association of hospital volume with odds of complications (including related readmissions) or LOS. Elixhauser Comorbidity Sum (ECS) was used to categorize medical complexity. There were 11,388 aTSA, 19,328 rTSA, and 95 primary revision TSA patients. LOS decreased by up to one and two days respectively on average with increasing hospital volume in TSA and rTSA patients. Logistic regression demonstrated that odds of complication in patients undergoing aTSA were not affected by hospital volume, yet LOS increased in lower quartile facilities (1.38, p < .05). For revision TSA, there was no clinical or statistical difference in LOS and composite complications regardless of hospital volume. When comparing the probability of re-admission or post-surgical complication based on ECS (value ≥ two) and annual hospital volume, only LOS in rTSA patients was adversely affected by lower volume facilities (1.68, p < .05), with lower volume facilities having a longer LOS. The odds of readmission or postoperative complication is similar across facilities of varying annual surgical volume. Only LOS for rTSA patients appeared to be adversely affected based on annual hospital volume. Performance of revision shoulder arthroplasty at higher volume facilities warrants further study. Overall, aTSA and rTSA are safe procedures and with proper medical management can be performed in facilities of varying annual volume. Level III; Retrospective Cohort Comparison using Large Database; Prognosis Study.