Predictors for failed same-day discharge after total shoulder arthroplasty.

Background: Same-day discharge (SDD) after total shoulder arthroplasty (TSA) has gained popularity with expansion of TSA performed in the ambulatory setting. Prolonged post-operative length of stay remains challenging, contributing to increased health-care costs without improved outcomes. Identifying risk factors predictive of failed SDD is critical for optimizing patient selection for outpatient vs. inpatient post-operative care settings. The purpose of this study was to evaluate risk factors associated with failure of SDD after TSA. Methods: This was a retrospective review of 808 patients who underwent primary reverse or anatomic TSA between September 2016 and August 2025 at a single institution. Patients undergoing hemiarthroplasty and revision arthroplasty were excluded. Data collected included demographics, comorbidities, pre-operative laboratory and imaging findings, physical examination metrics, and perioperative pain control. SDD was defined as discharge within 24 hours of surgery; failure was defined as discharge >24 hours after surgery. Logistic regression models were used to evaluate potential predictors of SDD failure, controlling for age, body mass index, sex, laterality, race, and type of arthroplasty. The Benjamini-Hochberg procedure was applied to control for false discovery. Odds ratios with 95% confidence intervals were reported. Results: Among 808 patients, 377 (46%) achieved SDD. American Society of Anesthesiology (ASA) physical status classification was the only statistically significant predictor of SDD failure ( Conclusion: In this cohort, ASA classification was a significant predictor of failure for SDD after TSA. In particular, ASA Class 3 and 4 patients are at significant risk for length of stay >24 hours. These findings can inform clinical decision-making to optimize outpatient surgical pathways, improve patient counseling, and reduce health-care expenditures.