The transition to outpatient shoulder arthroplasty: a systematic review

Sandler, Alexis B.; Narimissaei, Danielle; McDaniel, Lea; Dunn, John C.; Parnes, Nata

doi:10.1016/j.jse.2022.01.154

Cited by 10 publications

(12 citation statements)

References 37 publications

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“…Retrospective studies and national databases find outpatient TSA to be safe, but there are issues of selection bias and confounding bias because outpatients were on average younger, thinner, and healthier [4 ▪▪ ,7 ▪ ,11 ▪ ]. Comparison between inpatient and outpatient surgery showed noninferiority of outpatient surgery for safety, when using matched controls [7 ▪ ].…”

Section: Patient Selection and Safetymentioning

confidence: 99%

“…TSA was removed from the federal inpatient-only list [6 ▪ ]. Concerns about COVID-19 may make patients skeptical about inpatient stays [4 ▪▪ ]. Shorter stays are associated with a charge reduction of $25 509 to $52 202 per patient [7 ▪ ].…”

Section: Reasons For Ambulatory Total Shoulder Arthroplastymentioning

confidence: 99%

“…Peripheral nerve blockade is frequently recommended by pathways for TSA [4 ▪▪ ]. Long-duration nerve blockade reduces pain and opioid use after shoulder surgery [5,12 ▪ ,13 ▪▪ ].…”

Section: Analgesic Pathway Componentsmentioning

confidence: 99%

“…Several factors promote ambulatory TSA [4 ▪▪ ]. Total knee and total hip arthroplasty, which are arguably more invasive, are often ambulatory.…”

Section: Reasons For Ambulatory Total Shoulder Arthroplastymentioning

confidence: 99%

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Clinical care pathways for ambulatory total shoulder arthroplasty

Dong

YaDeau

2022

Current Opinion in Anaesthesiology

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Purpose of reviewTotal shoulder arthroplasty (TSA) is growing in popularity and is increasingly done on an ambulatory basis. This review examines recent developments in anesthesia and analgesia for ambulatory shoulder surgery. Pathway components are discussed and a sample pathway is described. Recent FindingsAdoption of pathways for shoulder surgery improves patient experience by reducing pain, opioid use, and side effects while improving patient satisfaction. Long-acting nerve blockade using adjuvants like dexamethasone provide long-lasting analgesia without rebound pain. Peripheral nerve blockade provides better analgesia than peri-articular injection of local anesthetic. There are multiple approaches to nerve blockade for shoulder surgery to consider, including interscalene, superior trunk, supraclavicular, and anterior suprascapular nerve blocks. Multimodal analgesia should include acetaminophen and nonsteroidal anti-inflammatory drugs, but routine gabapentinoids should not be used.

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Section: Patient Selection and Safetymentioning

confidence: 99%

Section: Reasons For Ambulatory Total Shoulder Arthroplastymentioning

confidence: 99%

Section: Analgesic Pathway Componentsmentioning

confidence: 99%

“…Several factors promote ambulatory TSA [4 ▪▪ ]. Total knee and total hip arthroplasty, which are arguably more invasive, are often ambulatory.…”

Section: Reasons For Ambulatory Total Shoulder Arthroplastymentioning

confidence: 99%

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Clinical care pathways for ambulatory total shoulder arthroplasty

Dong

YaDeau

2022

Current Opinion in Anaesthesiology

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“…There are a series of systematic reviews and meta-analyses presenting aggregated information around safety and feasibility for SDD following joint replacement [33 ▪▪ ,34 ▪▪ ], hysterectomy [35 ▪▪ ], radical prostatectomies [36 ▪▪ ] and thyroidectomy [37 ▪▪ ].…”

Section: Experience In More Extensive Surgeriesmentioning

confidence: 99%

Ambulatory anesthesia and discharge: an update around guidelines and trends

Rohi

Olofsson

Jakobsson

2022

Current Opinion in Anaesthesiology

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Purpose of reviewProvide an oversight of recent changes in same-day discharge (SDD) of patient following surgery/anesthesia.Recent findingsEnhanced recovery after surgery pathways in combination with less invasive surgical techniques have dramatically changed perioperative care. Preparing and optimizing patients preoperatively, minimizing surgical trauma, using fast-acting anesthetics as well as multimodal opioid-sparing analgesia regime and liberal prophylaxis against postoperative nausea and vomiting are basic cornerstones. The scope being to maintain physiology and minimize the impact on homeostasis and subsequently hasten and improve recovery.SummaryThe increasing adoption of enhanced protocols, including the entire perioperative care bundle, in combination with increased use of minimally invasive surgical techniques have shortened hospital stay. More intermediate procedures are today transferred to ambulatory pathways; SDD or overnight stay only. The traditional scores for assessing discharge eligibility are however still valid. Stable vital signs, awake and oriented, able to ambulate with acceptable pain, and postoperative nausea and vomiting are always needed. Drinking and voiding must be acknowledged but mandatory. Escort and someone at home the first night following surgery are strongly recommended. Explicit information around postoperative care and how to contact healthcare in case of need, as well as a follow-up call day after surgery, are likewise of importance. Mobile apps and remote monitoring are techniques increasingly used to improve postoperative follow-up.

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