Background: Surgeons have begun to transition total shoulder arthroplasty (TSA) to the outpatient setting in order to contain costs and reallocate resources. Purpose: The purpose of this systematic review was to evaluate the safety and cost of outpatient TSA by assessing associated complication rates, clinical outcomes, and total treatment charges. Methods: The MEDLINE, Embase, and Cochrane Library online databases were queried in March 2020 for studies on outpatient shoulder arthroplasty. Inclusion criteria were (1) a study population undergoing TSA, (2) discharge on the day of surgery, and (3) inclusion of at least 1 reported outcome. Results: Of 20 studies identified that met inclusion criteria, 14 were comparative studies involving an inpatient control group, 2 of which were matched by age and comorbidities. The remaining studies used control groups consisting of inpatient TSAs who were older or more medically infirm according to American Society of Anesthesiologists (ASA) or Charlson Comorbidity Index (CCI) scores. The combined average age of the outpatient and inpatient groups was 66.5 and 70.1 years, respectively. Patients who underwent outpatient TSA had similar rates of readmissions, emergency department visits, and perioperative complications in comparison to inpatients. Patients also reported comparably high levels of satisfaction with outpatient procedures. Four economic analyses demonstrated substantial cost savings with outpatient TSA in comparison to inpatient surgery. Conclusion: In carefully selected patients, outpatient TSA appears to be equally safe but less resource intensive than inpatient arthroplasty. Nonetheless, there remains a need for larger prospective studies to decisively characterize the relative safety of outpatient TSA among patients with similar baseline health.
Background: Surgeons have begun to transition total shoulder arthroplasty (TSA) to the outpatient setting in order to contain costs and reallocate resources. Purpose: The purpose of this systematic review was to evaluate the safety and cost of outpatient TSA by assessing associated complication rates, clinical outcomes, and total treatment charges. Methods: The MEDLINE, Embase, and Cochrane Library online databases were queried in March 2020 for studies on outpatient shoulder arthroplasty. Inclusion criteria were (1) a study population undergoing TSA, (2) discharge on the day of surgery, and (3) inclusion of at least 1 reported outcome. Results: Of 20 studies identified that met inclusion criteria, 14 were comparative studies involving an inpatient control group, 2 of which were matched by age and comorbidities. The remaining studies used control groups consisting of inpatient TSAs who were older or more medically infirm according to American Society of Anesthesiologists (ASA) or Charlson Comorbidity Index (CCI) scores. The combined average age of the outpatient and inpatient groups was 66.5 and 70.1 years, respectively. Patients who underwent outpatient TSA had similar rates of readmissions, emergency department visits, and perioperative complications in comparison to inpatients. Patients also reported comparably high levels of satisfaction with outpatient procedures. Four economic analyses demonstrated substantial cost savings with outpatient TSA in comparison to inpatient surgery. Conclusion: In carefully selected patients, outpatient TSA appears to be equally safe but less resource intensive than inpatient arthroplasty. Nonetheless, there remains a need for larger prospective studies to decisively characterize the relative safety of outpatient TSA among patients with similar baseline health.
Authors: Manpreet Banghu; Thomas Mutter; James Dubberley; Peter MacDonald; Brenden Dufault; Ryan Amadeo Journal: Can J Anaesth Date: 2016-12-05 Impact factor: 5.063
Authors: John C Dunn; Joseph Lanzi; Nicholas Kusnezov; Julia Bader; Brian R Waterman; Philip J Belmont Journal: J Shoulder Elbow Surg Date: 2015-01-13 Impact factor: 3.019
Authors: R Michael Meneghini; Mary Ziemba-Davis; Marshall K Ishmael; Alexander L Kuzma; Peter Caccavallo Journal: J Arthroplasty Date: 2017-03-14 Impact factor: 4.757
Authors: Jordan D Walters; Ryan N Walsh; Richard A Smith; Tyler J Brolin; Frederick M Azar; Thomas W Throckmorton Journal: J Am Acad Orthop Surg Date: 2020-10-01 Impact factor: 3.020
Authors: Richard A Berger; Sheila A Sanders; Elizabeth S Thill; Scott M Sporer; Craig Della Valle Journal: Clin Orthop Relat Res Date: 2009-02-28 Impact factor: 4.176