title: Length of stay after shoulder arthroplasty-the effect of an orthopedic specialty hospital.
abstract: BACKGROUND
  One potential avenue for the realization of health care savings is reduction in hospital length of stay (LOS). Initiatives to reduce LOS may also reduce infection and improve patient satisfaction. We compare LOS after shoulder arthroplasty at an orthopedic specialty hospital (OSH) and a tertiary referral center (TRC).
  
  
  METHODS
  A single institutional database was used to retrospectively identify all primary shoulder arthroplasties performed between January 1, 2013, and July 1, 2015, at the OSH and TRC. Manually matched cohorts from the OSH and TRC were compared for LOS and readmission rate.
  
  
  RESULTS
  There were 136 primary shoulder arthroplasties performed at the OSH matched with 136 at the TRC during the same study period. OSH and TRC patients were similar in age (P = .949), body mass index (P = .967), Charlson Comorbidity Index (P = 1.000), gender (both 52.21% male), procedure (69.12% total shoulder arthroplasty, 7.35% hemiarthroplasty, and 23.53% reverse shoulder arthroplasty), insurance status (P = .714), and discharge destination (P = .287). Despite equivalent patient characteristics, average LOS at the OSH was 1.31 ± 0.48 days compared with 1.85 ± 0.57 days at the TRC (t = 8.41, P < .0001). Of the 136 OSH patients, 3 (2.2%) required transfer to a TRC. Readmission rates for the OSH patients (2/136, 1.5%) and TRC patients (1/136, 0.7%) were similar (z = 0.585, P = .559).
  
  
  CONCLUSIONS
  LOS at the OSH was significantly shorter than at the TRC for a strictly matched cohort of patients. This may be a result of fast-track rehabilitation and strict disposition protocols at the OSH. With rising shoulder arthroplasty demand, utilization of an OSH may be a safe avenue to delivery of more efficient and effective orthopedic care.
authors.affiliation: Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Padegimas
authors.affiliation: Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Zmistowski
authors.affiliation: Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Corey T
authors.initials: CT
authors.lastname: Clyde
authors.affiliation: Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Camilo
authors.initials: C
authors.lastname: Restrepo
authors.affiliation: Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Abboud
authors.affiliation: Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Lazarus
authors.affiliation: Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Ramsey
authors.affiliation: Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Gerald R
authors.initials: GR
authors.lastname: Williams
authors.affiliation: Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: surena.namdari@rothmaninstitute.com.
authors.forename: Surena
authors.initials: S
authors.lastname: Namdari
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder; D015331:Cohort Studies; D005260:Female; D006782:Hospitals, Special; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000601:surgery
keywords: Shoulder arthroplasty; economic analysis; health care policy; length of stay; orthopedic specialty hospitals; reverse shoulder arthroplasty