Predictors of Length of Stay and Discharge Disposition After Shoulder Arthroplasty

A Systematic Review

Jacob E. Berman, MBA; Ana Mata-Fink, MD; Hafiz F. Kassam, MD; Theodore A. Blaine, MD; David Kovacevic, MD

Disclosures

J Am Acad Orthop Surg. 2019;27(15):e696-e701. 

In This Article

Methods

Search Methods and Study Eligibility Criteria

We searched MEDLINE, Scopus, Embase, and Cochrane Library databases from January 2000 to November 2017. To identify potentially relevant studies, we used key words to generate sets for shoulder arthroplasty, length of stay, and discharge disposition. Our search terms included "shoulder arthroplasty outcomes," "shoulder arthroplasty length of stay," "shoulder arthroplasty discharge disposition," and "shoulder arthroplasty factors." Our search had no limits, and we used no special strategies. We included studies that met the following prespecified criteria: (1) treatment with shoulder hemiarthroplasty, anatomic shoulder arthroplasty, and reverse shoulder arthroplasty; (2) examination of patient-specific factors associated with hospital length of stay after shoulder arthroplasty; (3) examination of hospital or surgeon factors associated with hospital length of stay; (4) examination of patient-specific factors associated with discharge disposition after shoulder arthroplasty; (5) examination of hospital or surgeon factors associated with discharge disposition; and (6) any study with evidence level IV or higher. Studies were excluded if they were not in English or if they lacked quantifiable data for relevant variables (ie, odds ratios [ORs] relating independent variables to the target dependent variables of length of stay and discharge disposition). Studies were also excluded if their patient data overlapped with data from another study, which included information on the same factors.

Outcome Measures

We specified hospital length of stay after shoulder arthroplasty and discharge disposition after shoulder arthroplasty as the primary outcomes of interest. Length of stay was measured either in days or as extended length of stay (greater than 75th percentile). Discharge disposition was classified as either discharge to home or discharge to a facility.

Study Selection

All institutional and author information was concealed to minimize reviewer bias. After removing duplicates, two reviewers screened the unique records retrieved from our search by title and abstract. Full-text assessment on those articles that seemed to meet our inclusion criteria was performed in duplicate, with two independent reviewers assessing each article. Discrepancies were resolved by a consensus or by an independent third-party reviewer if a consensus could not be reached.

Data Collection

We collected data from those articles that met our inclusion criteria after full-text assessment. A standardized data collection form completed by two independent reviewers to extract details related to demographics, intervention, and outcomes was used. Discrepancies were resolved by a consensus or by an independent third-party reviewer if a consensus could not be reached.

Analysis and Data Synthesis

The effect of patient demographics and medical comorbidities on length of stay and discharge disposition after shoulder arthroplasty were generally reported as ORs with variable reference values. The different reference values made quantitative assessment unfeasible. Therefore, the effects were evaluated qualitatively for their association with increased length of stay and discharge to a facility. Similarly, hospital and surgeon volume were tabulated and qualitatively assessed for their association with the outcomes of interest. Only statistically significant data were included in this systematic review. Statistical significance was defined as P ≤ 0.05.

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