Abstract
BackgroundOutpatient shoulder arthroplasty is growing in popularity as a cost-effective and potentially equally safe alternative to inpatient arthroplasty. The aim of this study was to investigate literature relating to outpatient shoulder arthroplasty, looking at clinical outcomes, complications, readmission, and cost compared to inpatient arthroplasty.MethodsWe conducted a systematic review of Medline, Embase and Cochrane Library databases from inception to 6 April 2020. Methodological quality was assessed using MINORS and GRADE criteria.ResultsWe included 17 studies, with 11 included in meta-analyses and 6 in narrative review. A meta-analysis of hospital readmissions demonstrated no statistically significant difference between outpatient and inpatient cohorts (OR = 0.89, p = 0.49). Pooled post-operative complications identified decreased complications in those undergoing outpatient surgery (OR = 0.70, p = 0.02). Considerable cost saving of between $3614 and $53,202 (19.7–69.9%) per patient were present in the outpatient setting. Overall study quality was low and presented a serious risk of bias.DiscussionShoulder arthroplasty in the outpatient setting appears to be as safe as shoulder arthroplasty in the inpatient setting, with a significant reduction in cost. However, this is based on low quality evidence and high risk of bias suggests further research is needed to substantiate these findings.
Highlights
We identified a total of 590 studies from a comprehensive search of databases
The primary finding of this review is that in appropriate selection of patients based on age, health status, outpatient shoulder arthroplasty is as safe as arthroplasty performed in the inpatient setting
Overall the findings from this review demonstrate no increased risk of complications following outpatient shoulder arthroplasty as compared to arthroplasty performed in the inpatient setting
Summary
Shoulder arthroplasty can provide significant improvement in quality of life for patients with end stage glenohumeral joint disease. The number of shoulder arthroplasties performed annually are increasing given an ageing population, expanded indications, improved techniques and advances in implant design. Given this rise, demand on health services is rising and likely to put an increased strain on hospital resources and expenditure in the upcoming years. In response to this and increased patient interest, outpatient shoulder arthroplasty is growing in popularity. Previous barriers to performing arthroplasty in the outpatient setting were concerns over the management of pain, bleeding and post-operative medical complications; improvements in pre-operative optimisation of patients, perioperative management of pain with use of anaesthetic blocks, and overall improvements in surgical technique and intraoperative management of blood loss have addressed some of these concerns.S Shoulder & Elbow 0(0). The number of shoulder arthroplasties performed annually are increasing given an ageing population, expanded indications, improved techniques and advances in implant design.2 Given this rise, demand on health services is rising and likely to put an increased strain on hospital resources and expenditure in the upcoming years.. Discussion: Shoulder arthroplasty in the outpatient setting appears to be as safe as shoulder arthroplasty in the inpatient setting, with a significant reduction in cost. This is based on low quality evidence and high risk of bias suggests further research is needed to substantiate these findings
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