The safety of outpatient total shoulder arthroplasty: a systematic review and meta-analysis

Abdulaziz F Ahmed,Saeed Qaimkhani,Mohammed Al Ateeq Al Dosari,Ammar Toubasi,Ghalib O Ahmed,Ashraf Hantouly,Osama Alzobi,Shady Mahmoud

doi:10.1007/s00264-021-04940-7

Abstract

PurposeTo meet the increasing demands of total shoulder arthroplasty (TSA) while reducing its financial burden, there has been a shift toward outpatient surgery. This systematic review and meta-analysis aimed to evaluate the safety of outpatient TSA.MethodsThe primary objective was to compare re-admission rates and postoperative complications in outpatient versus inpatient TSA. The secondary objectives were functional outcomes and costs. PubMed, Google Scholar, and Web of Science were searched until March 28, 2020. The inclusion criteria were studies reporting at least complications or readmission rates within a period of 30 days or more.ResultsTen level III retrospective studies were included with 7637 (3.8%) and 192,025 (96.2%) patients underwent outpatient and inpatient TSA, respectively. Outpatient TSA had relatively younger and healthier patients. There were no differences between outpatient and inpatient arthroplasty for 30- and 90-day readmissions. Furthermore, unadjusted comparisons demonstrated significantly less total and major surgical complications, less total, major, and minor medical complications in favour of outpatient TSA. However, subgroup analyses demonstrated that there were no significant differences in all complication if the studies had matched controls and regardless of data source (database or nondatabase studies). The revision rates were similar between both groups at a 12–24 months follow-up. Two studies reported a significant reduction in costs in favour of outpatient TSA.ConclusionThis study highlights that outpatient TSA could be a safe and effective alternative to inpatient TSA in appropriately selected patients. It was evident that outpatient TSA does not lead to increased readmissions, complications, or revision rates. A potential additional benefit of outpatient TSA was cost reduction.

Highlights

Total shoulder arthroplasty (TSA) is a successful procedure to treat end-stage glenohumeral osteoarthritis, rotator cuff arthropathy, and proximal humerus fractures
Outpatient TSA was defined as having a length of stay less than 24 hours following TSA, whereas the inpatient counterpart was defined as having a length of stay for more than 24 hours
There was no difference in isolated pulmonary comorbidities (18.9% vs 18.8%). These results suggest that current patient selection for outpatient TSA results in a relatively healthier patient population

Summary

Introduction

Total shoulder arthroplasty (TSA) is a successful procedure to treat end-stage glenohumeral osteoarthritis, rotator cuff arthropathy, and proximal humerus fractures. In an economic analysis on TSA, 24% of total costs per patient were attributed to inpatient costs, whereas, 6% was due to 90-day followup costs [7]. There has been an increased interest in transitioning toward outpatient TSA, with a reported 107% increase over the past five years [8]. This transition has been motivated by the well-established safety and financial effectiveness of outpatient total hip and knee arthroplasty [9,10,11,12,13]

Methods

Results

Conclusion