Reverse shoulder replacement: a day-case procedure

Outpatient Shoulder Arthroplasty—A Systematic Review

“…Following full text review, 26 articles were included in the review (Figure 1). Of the included studies, 18 articles discussed complications, readmissions, and safety, [16][17][18][19]21,22,[24][25][26][27][28][29][30][31][32][33]40,41 7 articles discussed patient selection, 21,[27][28][29][30][31]40 6 articles discussed pain management, 20,28,[34][35][36][37] 6 articles discussed the cost implications of outpatient surgery, 15,22,23,30,38,41 2 articles discussed patient satisfaction, 24,32 and 1 article discussed surgeon satisfaction. 15 The level of evidence of the included articles ranges from Level II to Level V.…”

“…19,21,[25][26][27]30,31,41 Seven studies found higher complications with inpatient SA, 18,21,27,28,30,31,33 one study found higher complications in outpatient SA, 25 four studies found no differences in complications or readmissions, 19,22,29,41 one study had mixed findings, 26 and five studies did not compare inpatient and outpatient SA. 16,17,24,32,40 Brolin et al found no statistical difference between inpatient (10%) and outpatient (13%) complication rates when comparing 30 inpatient and outpatient SA performed by a single surgeon, 29 and Arshi et al found higher rates of surgical site infections (SSI) requiring irrigation and debridement at 6 months (OR ¼ 1.49; 95% confidence interval (CI), 1.01-2.19; P ¼ .045) and 1 year (OR ¼ 1.65; 95% CI, 1.15-2.35; P < .001) in an outpatient SA cohort. 26 Medical complications were more common in inpatient cohorts relative to outpatient SA patients, with complications ranging from 0%-17.7% for inpatients and 0%-15.9% for outpatients.…”

“…26 Medical complications were more common in inpatient cohorts relative to outpatient SA patients, with complications ranging from 0%-17.7% for inpatients and 0%-15.9% for outpatients. 16,18,21,22,24,25,28,30,31 Common complications identified in the inpatient vs outpatient cohorts were blood transfusion (range, 4.48-4.7% vs 0.49-3.5%), urinary tract infection (range 0.9-8.7% vs 0.58-6.8%) and acute kidney injury (range, 0.4-4.3% vs 0-4.5%). 27,30,31 Inpatient SA had a higher readmission rate compared to outpatient SA in several studies 21,27,30,33 (OR ¼ 1.8, P ¼ .016 for 30-day readmission and OR ¼ 1.8, P < .001 for 90-day readmission).…”

“…41 Smaller single-center studies have identified no difference in 90-day morbidity or mortality rates between inpatient and outpatient SA. 22,24,33 In contrast, Kramer et al found no differences between same-day discharge and in-hospital stay groups in terms of 90-day readmission (OR ¼ 0.71, 95% CI: 0.42-1.20), 90-day ED visits (OR ¼ 1.08, 95% CI: 0.80-1.47), and 1-year mortality (OR ¼ 1.61, 95% CI: 0.63-4.15), ultimately concluding that same-day discharge was not inferior to in-hospital stay SA in terms of 90-day readmission. 19 Harris et al found higher allcause 30-day readmission rates in the outpatient cohort (3.4% vs. 1.7%, P < .01), but no difference in 30-day readmissions specific to surgical complications (1.9% vs. 1.4%, P ¼ .32).…”

“…Two studies specifically addressed patient satisfaction following outpatient SA. 24,32 35 of 41 patients (85.4%) completed a post-surgical telephone questionnaire in the study by Leroux et al 32 94.3% of patients felt ready for outpatient discharge, and all but 2 patients (who needed an overnight stay in the ASC with 23-hour stay capabilities) stated they would have outpatient SA again. 97% of patients reported a good to excellent outpatient experience (poor, fair, average, good, excellent scale).…”