title: Predictors of extended length of stay after elective shoulder arthroplasty.
abstract: BACKGROUND
  With policymakers and hospitals increasingly looking to cut costs, length of stay after surgery has come into focus as an area for improvement. Despite the increasing popularity of total shoulder arthroplasty, there is limited research about the factors contributing to prolonged hospital stay. We sought to identify preoperative and postoperative predictors of prolonged hospital stay in patients undergoing anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA).
  
  
  METHODS
  Using the 2011 Nationwide Inpatient Sample, we identified an estimated 40,869 patients who underwent elective total shoulder arthroplasty (62.5% ATSA; 37.5% RTSA) and separated them into those with normal length of stay (<75th percentile) and prolonged length of stay (>75th percentile). Multivariate logistic regression modeling was performed to identify factors associated with prolonged length of stay.
  
  
  RESULTS
  Patient-level factors associated with prolonged length of stay common to patients undergoing ATSA or RTSA included increasing age, female sex, congestive heart failure, renal failure, chronic pulmonary disease, and preoperative anemia. Provider-related factors were lower volume and location in the South or Northeast. Postoperative complications showed a significant influence as well.
  
  
  CONCLUSIONS
  Our data can be used to promptly identify patients at higher risk of prolonged hospitalization after elective shoulder arthroplasty and to ultimately improve quality of care and cost containment.
authors: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA.
authors: Mariano E
authors: ME
authors: Menendez
authors: Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA; Medical University of South Carolina, College of Medicine, Charleston, SC, USA.
authors: Dustin K
authors: DK
authors: Baker
authors: Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Charles T
authors: CT
authors: Fryberger
authors: Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: bponce@uabmc.edu.
authors: Brent A
authors: BA
authors: Ponce
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000601:surgery*; D014481:United States / Q000453:epidemiology
keywords: NIS; Nationwide Inpatient Sample; Shoulder arthroplasty; anatomic total shoulder; length of stay; reverse total shoulder