Abstract:Background:
Little is known about patient perceptions of outpatient total shoulder arthroplasty (TSA). We evaluated patient-reported satisfaction with TSA in a freestanding ambulatory surgery center (ASC) and an inpatient (INPT) setting.
Methods:
Patients were mailed a survey regarding hospital admission, surgical site infections, and medical problems after surgery, as well as their satisfaction with the surgery and location. Patients were asked if, giv… Show more
“…Of these studies, 2 were removed owing to overlapping patients. 6 , 25 Thus, 7 studies accounting for 937 patients were ultimately included in the final qualitative assessment. 4 , 8 , 12 , 16 , 22 , 23 , 26 Figure 1 PRISMA flowchart of study selection.…”
Section: Resultsmentioning
confidence: 99%
“…However, three of these studies had overlapping patient data sets, and thus the study with the largest patient cohort was included and the two others by the same senior author were removed. 6 , 16 , 25 Owing to the absence of randomized controlled trials, pooled statistics and formal meta-analysis was not performed to avoid potentially inaccurate conclusions.…”
Background
As the number of total shoulder arthroplasties (TSAs) performed annually increases, some surgeons have begun to shift toward performing TSAs in the outpatient setting. However, it is imperative to establish the safety of outpatient TSA. The purpose of this systematic review was to define complication, readmission, and reoperation rates and patient-reported outcomes after outpatient TSA.
Methods
A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using three databases (PubMed, Ovid, and Embase). English-language publications describing results on complication rates in patients who underwent TSA in an outpatient or ambulatory setting were included. All nonclinical and deidentified database studies were excluded. Bias assessment was conducted with the methodologic index for nonrandomized studies criteria.
Results
Seven studies describing outcomes in outpatient TSA were identified for inclusion. The included studies used varying criteria for selecting patients for an outpatient procedure. The total outpatient 90-day complication rate (commonly including hematomas, wound issues, and nerve palsies) ranged from 7.1%-11.5%. Readmission rates ranged from 0%-3.7%, and emergency and urgent care visits ranged from 2.4%-16.1%. Patient-reported outcomes improved significantly after outpatient TSA in all studies. Two studies found a higher complication rate in the comparative inpatient cohort (
P
= .023-.027). Methodologic index for nonrandomized studies scores ranged from 9 to 11 (of 16) for noncomparative studies (n = 3), while all comparative studies received a score of a 16 (of 24).
Conclusion
Outpatient TSA in properly selected patients results in a similar complication rate to inpatient TSA. Further studies are needed to aid in determining proper risk stratification to direct patients to inpatient or outpatient shoulder arthroplasty.
“…Of these studies, 2 were removed owing to overlapping patients. 6 , 25 Thus, 7 studies accounting for 937 patients were ultimately included in the final qualitative assessment. 4 , 8 , 12 , 16 , 22 , 23 , 26 Figure 1 PRISMA flowchart of study selection.…”
Section: Resultsmentioning
confidence: 99%
“…However, three of these studies had overlapping patient data sets, and thus the study with the largest patient cohort was included and the two others by the same senior author were removed. 6 , 16 , 25 Owing to the absence of randomized controlled trials, pooled statistics and formal meta-analysis was not performed to avoid potentially inaccurate conclusions.…”
Background
As the number of total shoulder arthroplasties (TSAs) performed annually increases, some surgeons have begun to shift toward performing TSAs in the outpatient setting. However, it is imperative to establish the safety of outpatient TSA. The purpose of this systematic review was to define complication, readmission, and reoperation rates and patient-reported outcomes after outpatient TSA.
Methods
A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using three databases (PubMed, Ovid, and Embase). English-language publications describing results on complication rates in patients who underwent TSA in an outpatient or ambulatory setting were included. All nonclinical and deidentified database studies were excluded. Bias assessment was conducted with the methodologic index for nonrandomized studies criteria.
Results
Seven studies describing outcomes in outpatient TSA were identified for inclusion. The included studies used varying criteria for selecting patients for an outpatient procedure. The total outpatient 90-day complication rate (commonly including hematomas, wound issues, and nerve palsies) ranged from 7.1%-11.5%. Readmission rates ranged from 0%-3.7%, and emergency and urgent care visits ranged from 2.4%-16.1%. Patient-reported outcomes improved significantly after outpatient TSA in all studies. Two studies found a higher complication rate in the comparative inpatient cohort (
P
= .023-.027). Methodologic index for nonrandomized studies scores ranged from 9 to 11 (of 16) for noncomparative studies (n = 3), while all comparative studies received a score of a 16 (of 24).
Conclusion
Outpatient TSA in properly selected patients results in a similar complication rate to inpatient TSA. Further studies are needed to aid in determining proper risk stratification to direct patients to inpatient or outpatient shoulder arthroplasty.
“…This requires tremendous cooperation across several stakeholders such as surgeons, anesthesiologists, nurses, administration, insurance agencies, and rehabilitation services [15]. Several studies have shown that adjusting patient expectations, proper patient education, inquiry about living status such as the availability of assistance at home, and proximity to the surgical centre are crucial when considering outpatient pathways [16][17][18][19]. Furthermore, pain management should be carefully planned with the anaesthetists which can include preemptive analgesia, brachial plexus catheters, interscalene blocks, peri-articular injections, and post-operative multimodal pain management [16,20].…”
Section: Level Of Evidence: III Therapeuticmentioning
confidence: 99%
“…The total number of the population included was 199,662 cases of TSAs, with 7637 (3.8%) patients who underwent outpatient TSAs, and 192,025 (96.2%) patients underwent inpatient TSAs. Eight [8,16,17,19,[25][26][27][28] out of the ten studies reported readmission rates and nine studies reported postoperative complications. Two studies [8,25] reported costs in the form of total charges or cost per patient, and one study [18] reported shoulder functional scores.…”
Purpose
To meet the increasing demands of total shoulder arthroplasty (TSA) while reducing its financial burden, there has been a shift toward outpatient surgery. This systematic review and meta-analysis aimed to evaluate the safety of outpatient TSA.
Methods
The primary objective was to compare re-admission rates and postoperative complications in outpatient versus inpatient TSA. The secondary objectives were functional outcomes and costs. PubMed, Google Scholar, and Web of Science were searched until March 28, 2020. The inclusion criteria were studies reporting at least complications or readmission rates within a period of 30 days or more.
Results
Ten level III retrospective studies were included with 7637 (3.8%) and 192,025 (96.2%) patients underwent outpatient and inpatient TSA, respectively. Outpatient TSA had relatively younger and healthier patients. There were no differences between outpatient and inpatient arthroplasty for 30- and 90-day readmissions. Furthermore, unadjusted comparisons demonstrated significantly less total and major surgical complications, less total, major, and minor medical complications in favour of outpatient TSA. However, subgroup analyses demonstrated that there were no significant differences in all complication if the studies had matched controls and regardless of data source (database or nondatabase studies). The revision rates were similar between both groups at a 12–24 months follow-up. Two studies reported a significant reduction in costs in favour of outpatient TSA.
Conclusion
This study highlights that outpatient TSA could be a safe and effective alternative to inpatient TSA in appropriately selected patients. It was evident that outpatient TSA does not lead to increased readmissions, complications, or revision rates. A potential additional benefit of outpatient TSA was cost reduction.
“…Of the total of 37,652 reporting implant used: 34,939 (92.8%) participants underwent aTSA, 2705 (7.2%) underwent rTSA and 8 (0.02%) had HA. 1,[17][18][19][20][21][22][23][24][25][26][27] Of all, 52.9% reported the use of nerve blocks as adjuncts to anaesthesia, this equated to 9.9% of all participants included having a documented nerve block (Supplemental Table 3). The top three most prescribed analgesics were oxycodone (38.9%), paracetamol/acetaminophen (33.3%) and gabapentin (27.8%).…”
Background Outpatient shoulder arthroplasty is growing in popularity as a cost-effective and potentially equally safe alternative to inpatient arthroplasty. The aim of this study was to investigate literature relating to outpatient shoulder arthroplasty, looking at clinical outcomes, complications, readmission, and cost compared to inpatient arthroplasty. Methods We conducted a systematic review of Medline, Embase and Cochrane Library databases from inception to 6 April 2020. Methodological quality was assessed using MINORS and GRADE criteria. Results We included 17 studies, with 11 included in meta-analyses and 6 in narrative review. A meta-analysis of hospital readmissions demonstrated no statistically significant difference between outpatient and inpatient cohorts (OR = 0.89, p = 0.49). Pooled post-operative complications identified decreased complications in those undergoing outpatient surgery (OR = 0.70, p = 0.02). Considerable cost saving of between $3614 and $53,202 (19.7–69.9%) per patient were present in the outpatient setting. Overall study quality was low and presented a serious risk of bias. Discussion Shoulder arthroplasty in the outpatient setting appears to be as safe as shoulder arthroplasty in the inpatient setting, with a significant reduction in cost. However, this is based on low quality evidence and high risk of bias suggests further research is needed to substantiate these findings.
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