Day case vs inpatient total shoulder arthroplasty: A retrospective cohort study and cost-effectiveness analysis

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.…”

“…Outpatient SA rates have increased over time, and this trend is exemplified by the fact that 12/26 (46.2%) articles included in the review were published in 2019 or 2020. [16][17][18][19][20][21][22][23][24][25]40,41 With the push towards outpatient management of SA, it is important for institutions and individual physicians to independently determine if they are prepared to transition from the inpatient to outpatient setting using these evidence-based criteria for patient selection. All but two studies 25,26 examining complications and readmissions included in this review show either no difference or increased complication rates with inpatient SA compared to ambulatory SA, especially patients with diabetes or pulmonary or cardiac co-morbidities.…”

“…Six articles discussed the individual patient and overall societal cost implications of outpatient SA (Table 4). 22,23,30,38,39,41 All studies consistently reported that outpatient SA can significantly decrease costs associated with SA with average or median USD cost estimations for inpatient surgery ranging from $18,336 to $76,109 compared to $14,722 to $44,530 for outpatient surgery. 23,30,38,39,41 Centers performing a higher volume of SA were less expensive than lower volume centers.…”

“…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).…”