Neer Award 2016: Outpatient total shoulder arthroplasty in an ambulatory surgery center is a safe alternative to inpatient total shoulder arthroplasty in a hospital: a matched cohort study

• Published in: Journal of shoulder and elbow surgery Vol. 26; no. 2; pp. 204 - 208
• Main Authors: Brolin, Tyler J., MD, Mulligan, Ryan P., MD, Azar, Frederick M., MD, Throckmorton, Thomas W., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2017
• Subjects: Adult; Aged; ambulatory surgery center; Ambulatory Surgical Procedures; Arthroplasty, Replacement, Shoulder; Blood Transfusion; Cohort Studies; complications; cost-effectiveness; Female; hospital; Hospitalization; Humans; Joint Diseases - surgery; Male; Middle Aged; Orthopedics; outcomes; Reoperation; Retrospective Studies; safety; Shoulder Joint; Total shoulder arthroplasty; Treatment Outcome; Treatment Study; cost-effectiveness; complications; outcomes; safety; ambulatory surgery center; Retrospective Cohort Design; Total shoulder arthroplasty; hospital; Level III
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2016.07.011

Background Recent emphasis on safe and efficient delivery of high-quality health care has increased interest in outpatient total joint arthroplasty. The purpose of this study was to evaluate the safety of outpatient total shoulder arthroplasty (TSA) by comparing episode-of-care complications in matched cohorts of patients with anatomic TSA as an outpatient or inpatient procedure. Methods Thirty patients with outpatient TSA at a freestanding ambulatory surgery center (ASC) were compared with an age- and comorbidities-matched cohort of 30 patients with traditional inpatient TSA to evaluate 90-day episode-of-care complications, including hospital admissions or readmissions and reoperations. Two-tailed t -tests were used to evaluate differences, and differences of P  < .05 were considered statistically significant. Results No significant differences were found between the ASC and hospital cohorts regarding average age, preoperative American Society of Anesthesiologists score, operative indications, or body mass index. No patient required reoperation. There were no hospital admissions from the ASC cohort and no readmissions from the hospital cohort. Minor complications in the ASC cohort were arthrofibrosis in 2 patients and mild asymptomatic anterior subluxation in 1 patient; the only major complication was in an outpatient who fell 11 weeks after surgery and disrupted his subscapularis repair. Three minor complications in the hospital cohort were mild asymptomatic anterior subluxation, blood transfusion, and superficial venous thrombosis. The complication rates (13% vs. 10%) were not significantly different. Conclusions Outpatient TSA is a safe alternative to hospital admission in appropriately selected patients. Further investigation is warranted to evaluate the longer term outcomes and cost-effectiveness of outpatient TSA.