Optimizing primary total shoulder arthroplasty in the COVID era: shorter length of stay with no increase in the complication profile

The novel coronavirus (COVID-19) pandemic had significant impact on surgical volume of total shoulder arthroplasty (TSA) with a 55% decline during the second quarter of 2020. As restrictions eased, TSA volume recovered back to its prepandemic baseline by Q3/Q4. The purpose of this study was (1) to compare the postoperative length of stay (LOS), discharge disposition, complications, emergency department (ED) utilization, hospital readmissions, and reoperations within 90 days following TSA before and during the pandemic era and (2) to evaluate surgical trends of TSA induced by the pressures of the global pandemic. All patients undergoing either primary anatomic or reverse TSA between January 2018 and December 2021 were included. Procedures performed before March 11, 2020 were considered the “pre-COVID” cohort while those after were considered the “COVID era” cohort. The outcome measures included postoperative LOS, discharge disposition, complications, ED utilization, hospital readmissions, and reoperations within 90 days following TSA. P < .05 was considered statistically significant. There were 227 and 96 patients in the pre-COVID and COVID era groups, respectively. There were no differences in age (P = .6), gender (P = .06), body mass index (P = .33), Elixhauser Comorbidity Index (P = .8), TSA indication (P = .65), or arthroplasty type (P = .61) between pre-COVID and COVID cohorts. During the pandemic, there was a significant increase in same-day discharge TSA (49% vs. 28.2%, P < .001), and 37.9% of pre-COVID patients had a LOS between 1 and 2 days as compared to 18.8% in the COVID era group. Ultimately, there were no differences in any complications or frequency of 30- or 90-day ED encounters, readmissions, or reoperations between pre-COVID and COVID era cohorts (P > .05 for all). Primary TSA during the pandemic was associated with more frequent same-day discharge without increased postoperative complications, ED encounters, readmissions, or reoperations at up to 90-days postoperatively. Our results suggest that primary TSA, a procedure historically associated with an inpatient stay, can safely be performed expeditiously in an outpatient setting without increasing patient morbidity or mortality.