Outpatient Shoulder Arthroplasty at an Ambulatory Surgery Center Using a Multimodal Pain Management Approach

Abstract

Introduction:Early reports of outpatient shoulder arthroplasty are promising, although a paucity of outcome data exists, particularly for the outpatient shoulder arthroplasty performed at a freestanding ambulatory surgery center (ASC).Methods:A retrospective analysis of 61 shoulder arthroplasty procedures (21 consecutive outpatients and 40 inpatients) was performed. Outpatient shoulder arthroplasties were conducted at a freestanding ASC using a multimodal pain regimen without the use of regional anesthesia. The primary outcome was 90-day postoperative complication rate. Secondary outcomes included 90-day hospital admissions or readmissions, emergency department and urgent care visits, revision surgeries, mortality, postoperative pain, and functional scores.Results:No major complications, readmissions, revision surgeries, or deaths occurred in the outpatient cohort. The rate of 90-day complications was 9.5% and 17.5% for the outpatient and inpatient cohorts, respectively. All patients who had their shoulder arthroplasty as an outpatient were discharged home the day of surgery. No complications related to the outpatient protocol were observed. However, 4.8% of those who had outpatient surgery visited an emergency department or urgent care within 90 days compared with 5.0% of those who had surgery as an inpatient.Discussion:Outpatient shoulder arthroplasty can be performed safely and predictably in select patients at an ASC using a multimodal pain regimen without regional nerve block.

Demographic and clinical factors associated with same-day discharge and unplanned readmission following shoulder arthroplasty: a retrospective cohort study

“…From 1993 to 2007, there has been roughly a 2-fold reduction in postoperative hospital length of stay due to improvements in surgical technique and prosthetic design, preoperative patient education, use of intraoperative anesthetics allowing for rapid recovery, and postoperative multimodal analgesia. However, costs associated with shoulder arthroplasty have steadily increased [8][9][10]. Identifying factors and designing interventions mitigating barriers to cost control is therefore important.…”

Trends in total shoulder arthroplasty from 2005 to 2018: lower complications rates and shorter lengths of stay despite patients with more comorbidities

“…3 , 5 , 6 , 17 , 28 This phenomenon may be the result of an improved understanding of which patients are good candidates for outpatient TSA, improved care coordination, patient education, and advances in both multimodal pain management and regional anesthesia. 4 , 10 , 11 Although not evaluated in this study, patients discharged home, especially on the day of surgery, are generally younger and have fewer comorbidities. However, a study by Apostolakos et al 2 showed increased rates of short-term morbidity with non-home discharge, even after adjusting for comorbidities.…”

Pathogenesis, Evaluation, and Management of Osteolysis Following Total Ankle Arthroplasty

“…65 Malalignment, especially of the talar component, has been associated with reduced contact area, increased contact pressures, and higher rates of subsidence. 5,29 Additional, controlled studies are needed to evaluate the effect of implant design and contact pressures on periprosthetic osteolysis.…”