title: Preoperative risk factors for discharge to a postacute care facility after shoulder arthroplasty.
abstract: BACKGROUND
  Shoulder arthroplasty procedures are becoming increasingly prevalent in the United States due to expanding indications and an aging population. Most patients are discharged home, but a subset of patients is discharged to a postacute care (PAC) facility. The purpose of this study was to identify the risk factors for discharge to a PAC facility after shoulder arthroplasty.
  
  
  METHODS
  The Nationwide Inpatient Sample discharge records from 2011 to 2012 were analyzed for patients who underwent a total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA). Patient and hospital characteristics were identified. Univariate and multivariate analysis were used to determine the statistically significant risk factors for discharge to a PAC facility while controlling for covariates.
  
  
  RESULTS
  In 2011 and 2012, 103,798 patients underwent shoulder arthroplasty procedures: 58,937 TSAs and 44,893 RTSAs were identified. RTSA patients were 1.3 times as likely to be discharged to a PAC facility as TSA patients (P = .001). Medicare patients were 2 times as likely to be discharged to a PAC facility than those with private insurance (P < .001). In addition, women and patients presenting with a fracture, older age, or an increasing number of medical comorbidities were more likely to be discharged to a PAC facility (P < .001).
  
  
  CONCLUSIONS
  The risk factors identified in our study can be used to stratify patients at high risk for postoperative discharge to PAC, allowing for greater improvement in overall care and the facilitation of postoperative discharge planning.
authors.affiliation: Department of Orthopaedic Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA. Electronic address: sivasund@usc.edu.
authors.forename: Lakshmanan
authors.initials: L
authors.lastname: Sivasundaram
authors.affiliation: Department of Orthopaedic Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.
authors.forename: Nathanael
authors.initials: N
authors.lastname: Heckmann
authors.affiliation: Department of Orthopaedic Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Pannell
authors.affiliation: Department of Orthopaedic Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.
authors.forename: Ram K
authors.initials: RK
authors.lastname: Alluri
authors.affiliation: Department of Orthopaedic Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.
authors.forename: Reza
authors.initials: R
authors.lastname: Omid
authors.affiliation: Department of Orthopaedic Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.
authors.forename: George F Rick
authors.initials: GF
authors.lastname: Hatch
mesh_terms: D000367:Age Factors; D000368:Aged; D019643:Arthroplasty, Replacement; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D010351:Patient Discharge; D012112:Residential Facilities / Q000706:statistics & numerical data*; D012307:Risk Factors; D012737:Sex Factors; D012785:Shoulder Joint / Q000601:surgery*; D014481:United States / Q000453:epidemiology
keywords: Shoulder arthroplasty; database; discharge; nationwide; rehabilitation