The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Predictors of Return to Emergency Department and Readmission Following Primary Elective Total Shoulder Arthroplasty

Document Type : RESEARCH PAPER

Authors
Cameron Smith 1
Robert Ades 1
Yungtai Lo 2
Savino Stallone 3
Suhirad Khokhar 3
Konrad I. Gruson 3
1 Albert Einstein College of Medicine, Bronx, New York, United States
2 Albert Einstein College of Medicine - Department of Epidemiology & Population Health, Bronx, New York, United States
3 Montefiore Medical Center - Department of Orthopaedic Surgery, Bronx, New York, United States
10.22038/abjs.2024.77508.3581
Abstract
Objectives: Returns to the Emergency Department (ED) and unplanned readmissions within 90 days of 
shoulder arthroplasty represent a significant financial burden to healthcare systems. Identifying the 
reasons and risk factors could potentially reduce their prevalence. 
Methods: A retrospective review of primary anatomic (aTSA) and reverse shoulder arthroplasty (rTSA) cases from 
January 2016 through August 2023 was performed. Demographic patient and surgical data, including age, diagnosis 
of anxiety or depression, body mass index (BMI), smoking status, age-adjusted Charlson Comorbidity Index (ACCI), 
modified 5-item fragility index (mFI-5), and hospital length of stay (LOS) was collected. Patient visits to the ED within 
12 months prior to surgery were recorded. Predictors for return to the ED within 90 days postoperatively and any 
readmissions were determined. 
Results: There were 338 cases (167 aTSA and 171 rTSA), of which 225 (67%) were women. Patients with anxiety 
(OR=2.44, 95% CI 1.11–5.33; P=0.026), surgical postoperative complications (OR=3.22, 95% CI 1.36–7.58; 
P=0.008), ED visit within 3 months prior to surgery (OR=3.80, 95% CI 1.71–8.45; P=0.001), ED visit 3 to 6 months 
prior to surgery (OR=2.60, 95% CI 1.12–6.05; P=0.027), and ED visit 6 to 12 months prior to surgery (OR=2.12, 
95% CI 1.02–4.41; P=0.045) were more likely to have ED visit within 90 days postoperatively. Patients with prior 
ipsilateral shoulder surgery (OR=3.32, 95% CI 1.21–9.09; P=0.02), surgical postoperative complications (OR=13.92, 
95% CI 5.04–38.42; P<0.001), an ED visit within 3 to 6 months preoperatively (OR=8.47, 95% CI 2.84–25.27; 
P<0.001), and an mFI-5 ≥2 (OR=3.66, 95% CI 1.35–9.91; P=0.011) were more likely to be readmitted within 90 
days. 
Conclusion: Patients who present to the ED within 12 months prior to shoulder arthroplasty, those with anxiety, 
those with surgical complications and those with higher fragility should be monitored closely during the early 
postoperative period to minimize returns to the ED and/or unplanned readmissions. 
 Level of evidence: III
Keywords
90-day readmission
Modified fragility index
Return to emergency department
Risk factors
Subjects
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The Archives of Bone and Joint Surgery
Volume 12, Issue 7
July 2024
Pages 477-486

  • Receive Date 15 January 2024
  • Revise Date 13 May 2024
  • Accept Date 15 April 2024