*Article* **COVID-19 as a Catalyst for Same-Day Discharge Total Shoulder Arthroplasty**

**Mariano E. Menendez 1, Noah Keegan 1, Brian C. Werner 2 and Patrick J. Denard 1,\***


**Abstract:** The COVID-19 pandemic caused major disruptions to the healthcare system, but its impact on the transition to same-day discharge shoulder arthroplasty remains unexplored. This study assessed the effect of COVID-19 on length of stay (LOS), same-day discharge rates, and other markers of resource use after elective total shoulder arthroplasty. A total of 508 consecutive patients undergoing elective primary total shoulder arthroplasty between 2019 and 2021 were identified and divided into 2 cohorts: "pre-COVID" (March 2019–March 2020; *n* = 263) and "post-COVID" (May 2020–March 2021; *n* = 245). No elective shoulder arthroplasties were performed at our practice between 18 March and 11 May 2020. Outcome measures included LOS, same-day discharge, discharge location, and 90-day emergency department (ED) visits, readmissions and reoperations. There were no significant differences in baseline preoperative patient characteristics. Shoulder arthroplasty performed post-COVID was associated with a shorter LOS (12 vs. 16 h, *p* = 0.017) and a higher rate of same-day discharge (87.3 vs. 79.1%, *p* = 0.013). The rate of discharge to skilled nursing facilities was similarly low between the groups (1.9 vs. 2.0%, *p* = 0.915). There was a significant reduction in the rate of 90-day ED visits post-COVID (7.4 vs. 13.3%, *p* = 0.029), while there were no differences in 90-day reoperation (2.0 vs. 1.5%, *p* = 0.745) or readmission rates (1.2 vs. 1.9%, *p* = 0.724). The COVID-19 pandemic seems to have accelerated the shift towards shorter stays and more same-day discharge shoulder arthroplasties, while reducing unexpected acute health needs (e.g., ED visits) without adversely affecting readmission and reoperation rates.

**Keywords:** shoulder arthroplasty; COVID; coronavirus; length of stay; same-day discharge; pandemic
