Outpatient Shoulder Arthroplasty—A Systematic Review

Abstract

Objective Recent reports have shown that outpatient shoulder arthroplasty (SA) may be a safe alternative to inpatient management in appropriately selected patients. The purpose was to review the literature reporting on outpatient SA. Methods A systematic review of publications on outpatient SA was performed. Included publications discussed patients who were discharged on the same calendar day or within 23 hours from surgery. Articles were categorized by discussions on complications, readmissions, and safety, patient selection, pain management strategies, cost effectiveness, and patient and surgeon satisfaction. Results Twenty-six articles were included. Patients undergoing outpatient SA were younger and with a lower BMI than those undergoing inpatient SA. Larger database studies reported more medical complications for patients undergoing inpatient compared to outpatient SA. Articles on pain management strategies discussed both single shot and continuous interscalene blocks with similar outcomes. Both patients and surgeons reported high levels of satisfaction following outpatient SA, and cost analysis studies demonstrated significant cost savings for outpatient SA. Conclusion In appropriately selected patients, outpatient SA can be a safe, cost-saving alternative to inpatient care and may lead to high satisfaction of both patients and physicians, though further studies are needed to clarify appropriate utilization of outpatient SA.

Identifying risk factors for 30-day readmission after outpatient total shoulder arthroplasty to aid in patient selection

“…More recently, studies have found outpatient TSA to be safe and cost-effective in appropriately selected patients. 1 , 7 , 9 , 20 A meta-analysis performed by Cimino et al evaluated 26 studies and included 194,513 patients who underwent TSA, of whom 7162 underwent outpatient procedures. They reported that the overall likelihood of complications was significantly lower in outpatients compared to inpatients.…”

“…Technological and surgical advancements have allowed for TSA in the outpatient setting to become a practical alternative to inpatient procedures. 1 Changes in healthcare policy have also driven many hospital-based surgeries to the outpatient setting. 7 This is advantageous, as outpatient TSA has been shown to be more economically advantageous.…”

Clinical care pathways for ambulatory total shoulder arthroplasty

“…Improved surgical techniques and advances in anesthetic and analgesic management [5] make prolonged hospital stays seem superfluous for healthy patients. TSA was removed from the federal inpatient-only list [6 ▪ ]. Concerns about COVID-19 may make patients skeptical about inpatient stays [4 ▪▪ ].…”

“…Secondary failure remains an issue (i.e., the initial block works well but fails to provide long-duration analgesia). Discharging patients with a perineural catheter requires personnel and protocols to monitor outpatients and assist them with catheter management and removal [6 ▪ ]. Interestingly, a retrospective review [14] found that upper-extremity patients with continuous peripheral nerve catheters were 63% less satisfied than patients without a nerve block catheter (odds ratio 0.37).…”

“…It seems that it is not necessarily straightforward to use peripheral nerve catheters in all practice settings. A systematic review found that single injection and continuous interscalene blocks (ISBs) had similar outcomes for ambulatory TSA [6 ▪ ]. In the absence of a robust home catheter program, adjunct medications such as dexamethasone can be added to local anesthetic to prolong the duration of analgesia from a single-injection peripheral nerve block.…”