Discharge with home health care is associated with increased complications, readmission, and mortality following total shoulder arthroplasty

Background: Patients undergoing primary anatomic and reverse total shoulder arthroplasty (TSA) are often discharged with home health care (HHC) to provide access to at-home services and facilitate postoperative recovery and continued medical management. The purpose of this study was to evaluate the short-term postoperative outcomes of patients following primary TSA discharged with HHC, including medical and surgical complications, total cost of care, and total hospital length of stay (LOS). Methods: The Nationwide Readmissions Database was reviewed for patients who underwent elective primary TSA between 2016 and 2020 for a retrospective cohort analysis. Patients were stratified by discharge status following the inpatient admission, with 32,497 patients discharged with HHC and 116,402 patients discharged routinely with self-care. Patient demographics, preoperative medical comorbidities, postoperative medical and surgical complications within 180 days, cost of admission, and total hospital LOS were compared between the 2 discharge groups using chi(2) analyses. Further multivariate analysis was conducted to control for independent prognosticators on the effect of HHC on postoperative outcomes. Results: Discharge with HHC was correlated with significantly increased rates of all-cause medical complications (odds ratio [OR] 1.6, P < .001), surgical site infection (SSI) (OR 2.8, P < .001), hospital readmission (OR 1.3, P < .001), and death (OR 2.1, P < .001) within 180 days of primary TSA. Multivariate analysis suggests these correlations are independent risk factors and not due to patient demographics or preoperative medical comorbidities. Although discharge with HHC was found to be associated with increased hospital LOS (1.8 vs. 1.3 days, P < .001), there were no significant observed differences in cost of care. Conclusion: This study demonstrates that discharge with HHC compared with routine discharge while accounting for several preoperative comorbidities and demographic variables is associated with increased medical complications, SSI, readmission, and death within 180 days of TSA, but no increase in the overall patient cost. These findings suggest HHC disposition status can serve as a prognosticator for postoperative complications and can help guide clinician decision making when determining appropriate surgical candidacy. Level of evidence: Level III; Retrospective Cohort Comparison using Large Database; Prognosis Study (c) 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights are reserved, including those for text and data mining, AI training, and similar technologies.