Outcomes of ambulatory versus outpatient hospital-based surgical center shoulder arthroplasty: complications, readmissions, and charges.

Abstract

Purpose: The rising demand for primary total shoulder arthroplasty (TSA) has spurred interest in comparing the safety and cost-effectiveness of outpatient TSA in ambulatory surgical centers (ASCs) versus hospital-based centers (HSCs). This study evaluates ASCs and HSCs for medical complications, readmission rates, implant complications, and costs.

Methods: This retrospective cohort study used the PearlDiver Mariner Database to identify patients undergoing primary TSA in ASCs or HSCs, assessing medical complications, readmissions, implant issues, and costs. ASC patients were matched in a 1:5 ratio to HSC patients by age, sex, region, and Elixhauser Comorbidity Index (ECI). Logistic regression analyzed the impact of ASC versus HSC settings on complications and readmissions, while Welch's t-tests compared costs. Statistical significance was determined by a P value less than or equal to 0.05.

Results: ASCs showed lower odds of pulmonary embolism (OR = 0.69; P = 0.04), total medical complications (OR = 0.89; P = 0.01), prosthetic joint dislocation (OR = 0.43; P = 0.05), and total implant-related complications (OR = 0.85; P = 0.03), but a higher 90-day readmission rate (OR = 1.22; P < 0.01). ASCs also offered significant cost savings on the day of surgery ($4600 vs. $11,100; P < 0.01) and for 90-day total costs ($6600 vs. $13,500; P < 0.01) compared to HSCs.

Conclusion: Outpatient primary TSA in ASCs offers comparable safety with substantially lower costs than HSCs. Despite higher readmission rates, ASCs represent a viable, cost-effective alternative.