J Shoulder Elbow Surg. 2021 Mar 3:S1058-2746(21)00148-8. doi: 10.1016/j.jse.2021.02.007. Online ahead of print.
ABSTRACT
BACKGROUND: Amid rising healthcare costs and recent advances in surgical and anesthetic protocols, outpatient joint arthroplasty has risen steadily in recent years. While the safety of outpatient total knee arthroplasty (TKA) and total hip arthroplasty (THA) has been well-established, outpatient shoulder arthroplasty is still in its infancy. The purpose of this study is to synthesize the current literature and to provide further data regarding the outcomes and safety of outpatient shoulder arthroplasty.
METHODS: A systematic review was conducted following the standard PRISMA guidelines. Included were papers that evaluated the outcomes of patients undergoing outpatient total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA). Meta-analysis was conducted using Mantel-Haenszel statistics to generate odds ratios and their corresponding 95% confidence intervals comparing outpatient and inpatient shoulder arthroplasty.
RESULTS: Twelve studies were included with a total of 194,513 patients, of which, 7,162 were outpatients. Of the studies, eight were level III studies and four were level IV. The average age of the outpatients was 66.6 years and the average age of the inpatients was 70.1 years. The overall odds ratio of complications was significantly lower in outpatients (OR=0.40 [0.35-0.45]) than inpatients. There was no significant difference in 90-day readmission (OR=0.88 [0.75-1.03]), revision (OR=0.96 [0.65-1.41]), and infection rates (OR=0.93 [0.64-1.35]) when comparing outpatients to inpatients.
CONCLUSION: Outpatient total shoulder arthroplasty, in an appropriately selected patient population, is safe and results in comparable patient outcomes when compared to inpatient shoulder arthroplasty. Due to the expected increase in patients requiring total shoulder arthroplasty, surgeons, hospital administrators, and insurance carriers should strongly consider the merits of a cost and care efficient approach to total shoulder replacement.
PMID:33675972 | DOI:10.1016/j.jse.2021.02.007
