Advertisement

Inpatient Arthroscopic Rotator Cuff Repair Is Associated With Higher Postoperative Complications Compared With Same-Day Discharge: A Matched Cohort Analysis

      Purpose

      To compare 90-day postoperative complications between patients undergoing outpatient versus inpatient arthroscopic rotator cuff repairs (RCR) and identify risk factors associated with postoperative complications.

      Methods

      An administrative claims database was used to identify patients undergoing arthroscopic RCR from 2007 to 2015. Patients were categorized based on length of hospital stay (LOS) with inpatient RCR defined as patients with ≥1 day LOS, and outpatient RCR as patients discharged day of surgery (LOS = 0). Inpatient and outpatient RCR groups were matched based on age, sex, Charlson comorbidity index (CCI), and various medical comorbidities using 1:1 propensity score analysis. Patient factors, concomitant procedures, total adverse events (TAEs), medical adverse events (MAEs), and surgical adverse events (SAEs) were compared between the matched groups. Multiple logistic regression analysis was performed to identify risk factors associated with increased complications.

      Results

      After matching, there were 2812 patients (50% outpatient) included in the study. Within 90 days following arthroscopic RCR, the incidence of TAEs (8.9% vs 3.6%, P < .0001), SAEs (2.7% vs 0.9%, P = .0002), and MAEs (6.4% vs 3.0%, P < .0001) were significantly greater for the inpatient RCR group. The multivariate model identified inpatient RCR (LOS ≥1 day), greater CCI, and anxiety or depression as independent predictors for TAEs after arthroscopic RCR. Open biceps tenodesis and inpatient RCR were independent predictors of SAEs, whereas greater CCI, anxiety or depression, and inpatient RCR were independent predictors for MAEs within 90 days after arthroscopic RCR.

      Conclusions

      Inpatient arthroscopic RCR is associated with increased risk of 90-day postoperative complications compared with outpatient. However, there is no difference for all-cause or pain-related emergency department visits within 90 days after surgery. In addition, the multivariate model identified inpatient RCR, greater CCI, and diagnosis of anxiety or depression as independent risk factors for 90-day TAEs after arthroscopic RCR.

      Level of Evidence

      III, Retrospective cohort study
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Oh L.S.
        • Wolf B.R.
        • Hall M.P.
        • Levy B.A.
        • Marx R.G.
        Indications for rotator cuff repair: A systematic review.
        Clin Orthop Rel Res. 2007; 455: 52-63
        • Codman E.A.
        Complete rupture of the supraspinatus tendon. Operative treatment with report of two successful cases. 1911.
        J Shoulder Elbow Surg. 2011; 20: 347-349
        • Mather R.C.
        • Koenig L.
        • Acevedo D.
        • et al.
        The societal and economic value of rotator cuff repair.
        J Bone Joint Surg Am. 2013; 95: 1993-2000
        • Denard P.J.
        • Jiwani A.Z.
        • Ladermann A.
        • Burkhart S.S.
        Long-term outcome of a consecutive series of subscapularis tendon tears repaired arthroscopically.
        Arthroscopy. 2012; 28: 1587-1591
        • Ladermann A.
        • Denard P.J.
        • Burkhart S.S.
        Midterm outcome of arthroscopic revision repair of massive and nonmassive rotator cuff tears.
        Arthroscopy. 2011; 27: 1620-1627
        • Colvin A.C.
        • Egorova N.
        • Harrison A.K.
        • Moskowitz A.
        • Flatow E.L.
        National trends in rotator cuff repair.
        J Bone Joint Surg Am. 2012; 94: 227-233
        • Bozic K.J.
        Improving value in healthcare.
        Clin Orthop Rel Res. 2013; 471: 368-370
        • Nwachukwu B.U.
        • Hamid K.S.
        • Bozic K.J.
        Measuring value in orthopaedic surgery.
        JBJS Rev. 2013; 1https://doi.org/10.2106/JBJS.RVW.M.00067
        • Warrender W.J.
        • Syed U.A.M.
        • Hammoud S.
        • et al.
        Pain management after outpatient shoulder arthroscopy: A systematic review of randomized controlled trials.
        Am J Sports Med. 2017; 45: 1676-1686
        • Ng J.W.G.
        • Smith C.
        • Ilo K.
        • et al.
        Dedicated peri-operative pathway improved day case discharge rate for anterior cruciate ligament reconstructions.
        Eur J Orthop Surg Traumatol. 2019; 29: 639-644
        • Vitale M.A.
        • Vitale M.G.
        • Zivin J.G.
        • Braman J.P.
        • Bigliani L.U.
        • Flatow E.L.
        Rotator cuff repair: Aan analysis of utility scores and cost-effectiveness.
        J Shoulder Elbow Surg. 2007; 16: 181-187
        • Martin C.T.
        • Gao Y.
        • Pugely A.J.
        • Wolf B.R.
        30-day morbidity and mortality after elective shoulder arthroscopy: A review of 9410 cases.
        J Shoulder Elbow Surg. 2013; 22: 1667-1675.e1661
        • Basques B.A.
        • Erickson B.J.
        • Leroux T.
        • et al.
        Comparative outcomes of outpatient and inpatient total shoulder arthroplasty: An analysis of the Medicare dataset.
        Bone Joint J. 2017; 99-B: 934-938
        • Whiting P.S.
        • Rice C.D.
        • Avilucea F.R.
        • et al.
        Patients at increased risk of major adverse events following operative treatment of distal radius fractures: Inpatient versus Outpatient.
        J Wrist Surg. 2017; 6: 220-226
        • Weiser M.C.
        • Kim K.Y.
        • Anoushiravani A.A.
        • Iorio R.
        • Davidovitch R.I.
        Outpatient total hip arthroplasty has minimal short-term complications with the use of institutional protocols.
        J Arthroplasty. 2018; 33: 3502-3507
        • Valkering K.P.
        • van Bergen C.J.
        • Buijze G.A.
        • Nagel P.H.
        • Tuinebreijer W.E.
        • Breederveld R.S.
        Pain experience and functional outcome of inpatient versus outpatient anterior cruciate ligament reconstruction, an equivalence randomized controlled trial with 12 months follow-up.
        Knee. 2015; 22: 111-116
        • Tedder C.
        • DeBell H.
        • Dix D.
        • et al.
        Comparative analysis of short-term postoperative complications in outpatient versus inpatient total ankle arthroplasty: A database study.
        J Foot Ankle Surg. 2019; 58: 23-26
        • Qin C.
        • Dekker R.G.
        • Blough J.T.
        • Kadakia A.R.
        Safety and outcomes of inpatient compared with outpatient surgical procedures for ankle fractures.
        J Bone Joint Surg Am. 2016; 98: 1699-1705
        • Khanna R.
        • Kim R.B.
        • Lam S.K.
        • Cybulski G.R.
        • Smith Z.A.
        • Dahdaleh N.S.
        Comparing short-term complications of inpatient versus outpatient single-level anterior cervical discectomy and fusion: An analysis of 6940 patients using the ACS-NSQIP database.
        Clin Spine Surg. 2018; 31: 43-47
        • Huntley S.R.
        • McGee A.S.
        • Johnson J.L.
        • et al.
        Outcomes of inpatient versus outpatient elective foot and ankle surgery.
        Cureus. 2019; 11: e4058
        • Crawford D.C.
        • Li C.S.
        • Sprague S.
        • Bhandari M.
        Clinical and cost implications of inpatient versus outpatient orthopedic surgeries: A systematic review of the published literature.
        Orthop Rev. 2015; 7: 6177
        • Mulligan R.P.
        • Parekh S.G.
        Safety of outpatient total ankle arthroplasty vs traditional inpatient admission or overnight observation.
        Foot Ankle Int. 2017; 38: 825-831
        • Purger D.A.
        • Pendharkar A.V.
        • Ho A.L.
        • et al.
        Outpatient vs inpatient anterior cervical discectomy and fusion: A population-level analysis of outcomes and cost.
        Neurosurgery. 2018; 82: 454-464
        • Brolin T.J.
        • Mulligan R.P.
        • Azar F.M.
        • Throckmorton T.W.
        Neer Award 2016: Outpatient total shoulder arthroplasty in an ambulatory surgery center is a safe alternative to inpatient total shoulder arthroplasty in a hospital: A matched cohort study.
        J Shoulder Elbow Surg. 2017; 26: 204-208
        • Leroux T.S.
        • Basques B.A.
        • Frank R.M.
        • et al.
        Outpatient total shoulder arthroplasty: A population-based study comparing adverse event and readmission rates to inpatient total shoulder arthroplasty.
        J Shoulder Elbow Surg. 2016; 25: 1780-1786
        • Chin K.R.
        • Pencle F.J.R.
        • Coombs A.V.
        • Packer C.F.
        • Hothem E.A.
        • Seale J.A.
        Eligibility of outpatient spine surgery candidates in a single private practice.
        Clin Spine Surg. 2017; 30: E1352-E1358
        • Arshi A.
        • Park H.Y.
        • Blumstein G.W.
        • et al.
        Outpatient posterior lumbar fusion: A population-based analysis of trends and complication rates.
        Spine (Phila Pa 1976). 2018; 43: 1559-1565
        • Frank R.M.
        • Chalmers P.N.
        • Moric M.
        • Leroux T.
        • Provencher M.T.
        • Romeo A.A.
        Incidence and changing trends of shoulder stabilization in the United States.
        Arthroscopy. 2018; 34: 784-792
        • Ahn J.
        • Bohl D.D.
        • Tabaraee E.
        • Basques B.A.
        • Singh K.
        Current trends in outpatient spine surgery.
        Clin Spine Surg. 2016; 29: 384-386
        • Bernstein D.T.
        • Chen C.
        • Zhang W.
        • McKay S.D.
        National trends in operative treatment of pediatric fractures in the ambulatory setting.
        Orthopedics. 2015; 38: e869-e873
        • Best M.J.
        • Buller L.T.
        • Miranda A.
        National trends in foot and ankle arthrodesis: 17-year analysis of the National Survey of Ambulatory Surgery and National Hospital Discharge Survey.
        J Foot Ankle Surg. 2015; 54: 1037-1041
        • Mall N.A.
        • Chalmers P.N.
        • Moric M.
        • et al.
        Incidence and trends of anterior cruciate ligament reconstruction in the United States.
        Am J Sports Med. 2014; 42: 2363-2370
        • Soltani A.M.
        • Best M.J.
        • Francis C.S.
        • Allan B.J.
        • Panthaki Z.J.
        Trends in the surgical treatment of cubital tunnel syndrome: An analysis of the national survey of ambulatory surgery database.
        J Hand Surg Am. 2013; 38: 1551-1556
        • Bovonratwet P.
        • Ondeck N.T.
        • Nelson S.J.
        • Cui J.J.
        • Webb M.L.
        • Grauer J.N.
        Comparison of outpatient vs inpatient total knee arthroplasty: An ACS-NSQIP analysis.
        J Arthroplasty. 2017; 32: 1773-1778
        • Darrith B.
        • Frisch N.B.
        • Tetreault M.W.
        • Fice M.P.
        • Culvern C.N.
        • Della Valle C.J.
        Inpatient versus outpatient arthroplasty: A single-surgeon, matched cohort analysis of 90-day complications.
        J Arthroplasty. 2019; 34: 221-227
        • Sherman S.L.
        • Lyman S.
        • Koulouvaris P.
        • Willis A.
        • Marx R.G.
        Risk factors for readmission and revision surgery following rotator cuff repair.
        Clin Orthop Relat Res. 2008; 466: 608-613
        • DeMik D.E.
        • Bedard N.A.
        • Dowdle S.B.
        • et al.
        Complications and obesity in arthroplasty—a hip is not a knee.
        J Arthroplasty. 2018; 33: 3281-3287
        • Parkkinen M.
        • Madanat R.
        • Lindahl J.
        • Makinen T.J.
        Risk factors for deep infection following plate fixation of proximal tibial fractures.
        J Bone Joint Surg Am. 2016; 98: 1292-1297
        • Rasouli M.R.
        • Menendez M.E.
        • Sayadipour A.
        • Purtill J.J.
        • Parvizi J.
        Direct cost and complications associated with total joint arthroplasty in patients with preoperative anxiety and depression.
        J Arthroplasty. 2016; 31: 533-536
        • Wukich D.K.
        • Crim B.E.
        • Frykberg R.G.
        • Rosario B.L.
        Neuropathy and poorly controlled diabetes increase the rate of surgical site infection after foot and ankle surgery.
        J Bone Joint Surg Am. 2014; 96: 832-839
        • Bot A.G.
        • Menendez M.E.
        • Neuhaus V.
        • Ring D.
        The influence of psychiatric comorbidity on perioperative outcomes after shoulder arthroplasty.
        J Shoulder Elbow Surg. 2014; 23: 519-527
        • Harris A.H.
        • Reeder R.
        • Ellerbe L.
        • Bradley K.A.
        • Rubinsky A.D.
        • Giori N.J.
        Preoperative alcohol screening scores: Association with complications in men undergoing total joint arthroplasty.
        J Bone Joint Surg Am. 2011; 93: 321-327
        • Rasouli M.R.
        • Restrepo C.
        • Maltenfort M.G.
        • Purtill J.J.
        • Parvizi J.
        Risk factors for surgical site infection following total joint arthroplasty.
        J Bone Joint Surg Am. 2014; 96: e158
        • Ogura K.
        • Yasunaga H.
        • Horiguchi H.
        • Fushimi K.
        • Kawano H.
        What is the effect of advanced age and comorbidity on postoperative morbidity and mortality after musculoskeletal tumor surgery?.
        Clin Orthop Relat Res. 2014; 472: 3971-3978
        • Erickson B.J.
        • Basques B.A.
        • Griffin J.W.
        • et al.
        The effect of concomitant biceps tenodesis on reoperation rates after rotator cuff repair: A review of a large private-payer database from 2007 to 2014.
        Arthroscopy. 2017; 33: 1301-1307 e1301
        • Erickson B.J.
        • Cvetanovich G.L.
        • Nwachukwu B.U.
        • et al.
        Trends in the management of achilles tendon ruptures in the United States Medicare population, 2005-2011.
        Orthop J Sports Med. 2014; 2 (2325967114549948)
        • Erickson B.J.
        • Nwachukwu B.U.
        • Rosas S.
        • et al.
        Trends in medial ulnar collateral ligament reconstruction in the United States: A retrospective review of a large private-payer database from 2007 to 2011.
        Am J Sports Med. 2015; 43: 1770-1774