As the demand for elective orthopaedics grows, day-case arthroplasty is gaining popularity. The aim of this study was to create a safe and reproducible pathway for day-case shoulder arthroplasty (DCSA) based upon a literature review and discussion with the local multidisciplinary team (MDT).
Methods
A literature review was performed using OVID MEDLINE and Embase databases reporting 90-day complication and admission rates following DCSA. Minimum follow-up was 30 days. Day-case was defined as discharge on the same day of surgery.
Results
The literature review revealed a mean 90-day complication rate of 7.7% [range, 0–15.9%] and mean 90-day readmission rate of 2.5% [range 0−9.3%]. A pilot protocol was devised based upon the literature review and consisted of 5 phases: (1) pre-operative assessment, (2) intra-operative phase, (3) post-operative phase, (4) follow-up, and (5) readmission protocol. This was presented, discussed, amended, and ultimately ratified by the local MDT. In May 2021 the unit successfully completed its first day-case shoulder arthroplasty.
Discussion
This study proposes a safe and reproducible pathway for DCSA. Patient selection, well-defined protocols and communication within the MDT are important factors to achieve this. Further studies with extended follow-up will be needed to gauge long-term success within our unit.
LübbekeAReesJBareaC,et al.International variation in shoulder arthroplasty. Acta Orthop2017; 88: 592–599.
2.
WagnerEFarleyKHigginsI,et al.The incidence of shoulder arthroplasty: rise and future projections compared with hip and knee arthroplasty. J Shoulder Elbow Surg2020; 29: 2601–2609.
3.
MorganMDavies-JonesGIbrahimE,et al.Introduction of an enhanced recovery programme for total shoulder arthroplasty: report of a novel pathway. BMJ Open Quality2021; 10 p.e001371.
4.
BurtonBFinneranJAngersteinA, et al. Demographic and clinical factors associated with same-day discharge and `unplanned readmission following shoulder arthroplasty: a retrospective cohort study. Korean J Anesthesiol2021; 74: 30–37.
5.
HarrisABestMWeinerS,et al.Hospital readmission rates following outpatient versus inpatient shoulder arthroplasty. Orthopedics2021; 44: e173–e178.
BorakatiAAliANagarajC,et al.Day case vs inpatient total shoulder arthroplasty: a retrospective cohort study and cost-effectiveness analysis. World J Orthop2020; 11: 213–221.
8.
OdeGOdumSConnorP, et al.Ambulatory versus inpatient shoulder arthroplasty: a population-based analysis of trends, outcomes, and charges. JSES Int2020; 4: 127–132.
9.
AntonacciCVazquezOAlbertaF. Complications and readmissions following reverse total shoulder arthroplasty with same-day discharge. Semin Arthroplasty2020; 30: 242–249.
10.
ChanJCirinoCVargasL, et al. Peripheral nerve block use in inpatient and outpatient shoulder arthroplasty: a population-based study evaluating utilization and outcomes. Reg Anesth Pain Med2020; 45: 818–825.
11.
EricksonBShishaniYJonesS, et al. Outpatient vs. Inpatient reverse total shoulder arthroplasty: outcomes and complications. J Shoulder Elbow Surg2020; 29: 1115–1120.
12.
KramerJChanPPrenticeH,et al.Same-day discharge is not inferior to longer length of in-hospital stay for 90-day readmissions following shoulder arthroplasty. J Shoulder Elbow Surg2020; 29: 898–905.
13.
FournierMBrolinTAzarF,et al.Identifying appropriate candidates for ambulatory outpatient shoulder arthroplasty: validation of a patient selection algorithm. J Shoulder Elbow Surg2019; 28: 65–70.
14.
NelsonCMurphyWMulliganR,et al.A retrospective comparative study of patient satisfaction following ambulatory outpatient and inpatient total shoulder arthroplasty. Curr Orthop Pract2019; 30: 435–438.
15.
CharlesMCvetanovichGSumner-ParillaS,et al.Outpatient shoulder arthroplasty: outcomes, complications, and readmissions in 2 outpatient settings. J Shoulder Elbow Surg2019; 28: S118–S123.
16.
BeanBConnorPSchiffernS, et al.Outpatient shoulder arthroplasty at an ambulatory surgery center using a multimodal pain management approach. J Am Acad Orthop Surg Glob Res Rev2018; 2: e064.
17.
NwankwoCDuttonPMerrimanJ,et al.Outpatient total shoulder arthroplasty does not increase the 90-day risk of complications compared with inpatient surgery in prescreened patients. Orthopedics2018; 41: e563–e568.
18.
ArshiALeongNWangC, et al. Relative complications and trends of outpatient total shoulder arthroplasty. Orthopedics2018; 41: e400–e409.
19.
LerouxTZukeWSaltzmanB, et al. Safety and patient satisfaction of outpatient shoulder arthroplasty. JSES Open Access2018; 2: 13–17.
20.
BasquesBEricksonBLerouxT, et al. Comparative outcomes of outpatient and inpatient total shoulder arthroplasty. Bone Joint J2017; 99–B: 934–938.
21.
CancienneJBrockmeierSGulottaL,et al.Ambulatory total shoulder arthroplasty: a comprehensive analysis of current trends, complications, readmissions, and costs. J Bone Joint Surg2017; 99: 629–637.
22.
BrolinTMulliganRAzarF, et al.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. J Shoulder Elbow Surg2017; 26: 204–208.
23.
LerouxTBasquesBFrankR, et al. Outpatient total shoulder arthroplasty: a population-based study comparing adverse event and readmission rates to inpatient total shoulder arthroplasty. J Shoulder Elbow Surg2016; 25: 1780–1786.
24.
DunnJLanziJKusnezovN,et al.Predictors of length of stay after elective total shoulder arthroplasty in the United States. J Shoulder Elbow Surg2015; 24: 754–759.
25.
MatsenFLiNGaoH,et al.Factors affecting length of stay, readmission, and revision after shoulder arthroplasty. J Bone Joint Surg2015; 97: 1255–1263.
26.
PappouIViraniNClarkR,et al.Outcomes and costs of reverse shoulder arthroplasty in the morbidly obese. J Bone Joint Surg2014; 96: 1169–1176.
27.
GriffinJNovicoffWBrowneJ,et al.Morbid obesity in total shoulder arthroplasty: risk, outcomes, and cost analysis. J Shoulder Elbow Surg2014; 23: 1444–1448.
28.
KhaziZLuYPatelB,et al.Risk factors for opioid use after total shoulder arthroplasty. J Shoulder Elbow Surg2020; 29: 235–243.
29.
WilsonJFarleyKGottschalkM,et al.Preoperative opioid use is an independent risk factor for complication, revision, and increased health care utilization following primary total shoulder arthroplasty. J Shoulder Elbow Surg2021; 30: 1025–1033.
30.
JonesSAlnaibMKokkinakisM,et al.Pre-operative patient education reduces length of stay after knee joint arthroplasty. Ann R Coll Surg Engl2011; 93: 71–75.
31.
PeltCGilillandJEricksonJ,et al.Improving value in total joint arthroplasty: a comprehensive patient education and management program decreases discharge to post-acute care facilities and post-operative complications. J Arthroplasty2018; 33: 14–18.
32.
ChanJCirinoCHuangH, et al. Drain use is associated with increased odds of blood transfusion in total shoulder arthroplasty: a population-based study. Clin Orthop Relat Res2019; 477: 1700–1711.
33.
VeltmanELenguerrandEMoojenD, et al. Similar risk of complete revision for infection with single-dose versus multiple-dose antibiotic prophylaxis in primary arthroplasty of the hip and knee: results of an observational cohort study in the Dutch arthroplasty register in 242,179 patients. Acta Orthop2020; 91: 794–800.
34.
ThornleyPEvaniewNRiedigerM,et al.Postoperative antibiotic prophylaxis in total hip and knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. CMAJ Open2015; 3: E338–E343.
35.
ParviziJShohatNGehrkeT. Prevention of periprosthetic joint infection. Bone Joint J2017; 99–B: 3–10.
36.
ThompsonMSimondsRClingerB,et al.Continuous versus single shot brachial plexus block and their relationship to discharge barriers and length of stay. J Shoulder Elbow Surg2017; 26: 656–661.
37.
UpdegroveGStauchCPonnuruP,et al.Efficacy of local infiltration anesthesia versus interscalene nerve blockade for total shoulder arthroplasty. JSES Int2020; 4: 357–361.
38.
PauzenbergerLDomejMHeubererP, et al. The effect of intravenous tranexamic acid on blood loss and early post-operative pain in total shoulder arthroplasty. Bone Joint J2017; 99–B: 1073–1079.
39.
BaileyCAhujaMBartholomewK, et al.Guidelines for day-case surgery. Anaesthesia2019; 74: 778–792.
40.
WhitePFTangJWenderRH, et al. The effects of oral ibuprofen and celecoxib in preventing pain, improving recovery outcomes and patient satisfaction after ambulatory surgery. Anesth Analg2011; 112: 323–329.
41.
BarryGBaileyJSardinhaJ,et al.Factors associated with rebound pain after peripheral nerve block for ambulatory surgery. Brit J Anaesthesia2021; 126: 862–871.
42.
TomaOPersoonsBPogatzki-ZahnE, et al. PROSPECT Guideline for rotator cuff repair surgery: systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia2019; 74: 1320–1331.
43.
DayJRamseyMLauE, et al.Risk of venous thromboembolism after shoulder arthroplasty in the medicare population. J Shoulder Elbow Surg2015; 24: 98–105.
44.
PaynterJRaleyJKyrkosJ, et al. Routine postoperative laboratory tests are unnecessary after primary reverse shoulder arthroplasty. J Shoulder Elbow Surg2020; 29: 1656–1664.
45.
BullockGGarriguesGLedbetterL, et al.A systematic review of proposed rehabilitation guidelines following anatomic and reverse shoulder arthroplasty. J Orthop Sports Phys Ther2019; 49: 337–346.
46.
NamdariSHsuJBarronM,et al.Immediate postoperative radiographs after shoulder arthroplasty Are often poor quality and Do Not Alter care. Clin Orthop Relat Res2013; 471: 1257–1262.
47.
VillacisDChauhanAAsselmeierM,et al.Clinical utility of immediate postoperative radiographs following uncomplicated primary reverse shoulder arthroplasty. J Shoulder Elbow Surg2021; 30: 2370–2374.
48.
FraserJDanoffJManriqueJ,et al.Identifying reasons for failed same-day discharge following primary total hip arthroplasty. J Arthroplasty2018; 33: 3624–3628.
49.
MarshallSChungF. Discharge criteria and complications after ambulatory surgery. Anesth Analg1999; 88: 508–517.
GoyalNChenAPadgettS, et al. Otto aufranc award: a multicenter, randomized study of outpatient versus inpatient total hip arthroplasty. Clin Orthop Relat Res2017; 475: 364–372.
52.
GregoryJWetzigAWayneC,et al.Quantification of patient-level costs in outpatient total shoulder arthroplasty. J Shoulder Elbow Surg2019; 28: 1066–1073.
