Outpatient Total Shoulder Arthroplasty Does Not Increase the 90-Day Risk of Complications Compared With Inpatient Surgery in Prescreened Patients

Abstract

Outpatient total joint arthroplasty is becoming a more attractive option for hospitals, surgeons, and patients. In this study, the authors evaluated the safety of outpatient shoulder arthroplasty by comparing an outpatient cohort with an inpatient cohort. Ninety-day outcomes of consecutively performed elective shoulder arthroplasty cases from 2012 to 2016 were retrospectively reviewed. Patients were preoperatively assigned to outpatient or inpatient care. Primary outcomes were emergency department visits, readmissions, mortality, and surgical morbidity within 90 days of surgery. Two-tailed t tests were used to evaluate differences. Bivariate and multivariate logistic regressions were used to determine if the odds of emergency department visit, readmission, or complications were significantly different between the cohorts. There were 118 outpatient and 64 inpatient shoulder arthroplasty procedures. Mean age and American Society of Anesthesiologists score were lower in the outpatient group compared with the inpatient group-68.1 vs 72.4 years (P=.01) and 2.3 vs 2.6 (P<.01), respectively. In the multivariate logistic regression model including all arthroplasty cases, the odds of outpatient to inpatient readmission was significantly different (odds ratio, 0.181; P=.027). However, when only total shoulder arthroplasty cases were included, no difference was detected. No statistically significant difference was noted for number of emergency department visits, mortality, or surgical morbidity within 90 days of surgery in any of the models. There was 1 death in the ambulatory group at 28 days after surgery. On the basis of these findings, the authors believe that, for carefully selected patients, an outpatient shoulder arthroplasty protocol is safe when compared with inpatient protocols. [Orthopedics. 2018; 41(4):e563-e568.].

Complication rates and outcomes after outpatient shoulder arthroplasty: a systematic review

“… 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. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

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“…Instead, Kramer et al 22 used anesthesiologist and surgeon preference to make this decision. Four studies (Charles et al, 8 Nwankwo et al, 26 Erickson et al, 12 and Leroux et al 23 ) also took into account the patient’s current social and/or living situation. The mean American Society of Anesthesiologists (ASA) score was a mean of 2.3 for the 4 studies in which it was reported.…”

“…Retrospective investigations have demonstrated no significant differences between same-day discharge and inpatient TSA for several measures of perioperative complications including readmission rates, emergency department visits, and 1-year mortality. 6 , 8 , 22 , 26 Given that candidates for outpatient arthroplasty are generally healthier with fewer comorbidities, they may even have significantly lower complication rates postoperatively. 26 , 30 Additional studies have attempted to identify patient populations and characteristics that make them suitable candidates for outpatient arthroplasty procedure.…”

“… 6 , 8 , 22 , 26 Given that candidates for outpatient arthroplasty are generally healthier with fewer comorbidities, they may even have significantly lower complication rates postoperatively. 26 , 30 Additional studies have attempted to identify patient populations and characteristics that make them suitable candidates for outpatient arthroplasty procedure. This has included patient selection algorithms that are subsequently tested based on observed complications rates, including cardiopulmonary, thromboembolic events, wound complications, pain management issues, and readmission rates.…”

A systematic review of clinical outcomes for outpatient vs. inpatient shoulder arthroplasty

“…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%).…”