The Transition to Outpatient Shoulder Arthroplasty: A Systematic Review

Document Type

Journal Article

Publication Date

3-9-2022

Journal

Journal of shoulder and elbow surgery

DOI

10.1016/j.jse.2022.01.154

Keywords

Shoulder arthroplasty; outpatient arthroplasty; outpatient shoulder arthroplasty; outpatient total joint arthroplasty; outpatient total joint replacement; reverse shoulder arthroplasty; total shoulder arthroplasty

Abstract

BACKGROUND/HYPOTHESIS: Transitioning shoulder arthroplasty (SA) from an inpatient to outpatient procedure is associated with increased patient satisfaction and potentially decreased costs; however, concern exists about complications following same day discharge. We hypothesize that outpatient SA is associated with low rates of failed discharge, readmission, and complications, rendering it a safe and effective option for shoulder arthroplasty. METHODS: A systematic review of outpatient SA literature identified 16/447 studies with level III and IV evidence that met inclusion criteria with at least 90 days of follow-up. Data on patient demographics, pre- and postoperative protocols, surgery characteristics, failed discharge, complications, and readmission were collected and pooled for analysis. RESULTS: A total of 990 patients were included in analysis. Many studies identify specific institutional protocols for determining eligibility for outpatient SA including preoperative clearance from anesthesiology, identification of a perioperative caretaker, and exclusion of patients based on cardiac, pulmonary, or hematologic risk factors. Only 0.9% (n=7/788) failed same-day discharge and 2.1% (n=9/418) and 0.79% (n=2/252) presented to an emergency room or urgent care facility for a perioperative concern. Readmission rate was 1.3% (n=7/529) for periprosthetic fracture, arthrofibrosis, infection, subscapularis rupture, and anterior subluxation. Complications occurred in 7.0% of patients (n=70/990), with 5.4% (n=53/990) of patients experiencing a surgical complication and 1.7% (n=17/990) a medical complication. There were 28 total reoperations (2.9%, 28/955). DISCUSSION/CONCLUSION: Outpatient SA is associated with low rates of failed discharge, readmission, and complications. Additionally, the medical and surgical complications that occur after outpatient SA are unlikely to be prevented by the short inpatient stay characteristic of traditional SA. With careful screening measures to identify appropriate candidates for same day discharge, outpatient SA represents a safe approach to preventing unnecessary hospitalizations and to decrease costs associated with SA.

Department

School of Medicine and Health Sciences Student Works

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