Day case versus inpatient total shoulder arthroplasty: A systematic review and meta-analysis

Abstract

Background

A number of papers have been published comparing the safety and efficacy of day case and inpatient anatomic or reverse total shoulder arthroplasty. However, no systematic review of the literature has been published to date. The aim of this review was to determine if day case total shoulder arthroplasty (length of stay <24 h) leads to similar outcomes as standard-stay inpatients (length of stay ≥24 h).

Methods

The US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviewers were queried for publications utilizing keywords that were pertinent to total shoulder arthroplasty, day case, outpatient and inpatient, clinical or functional outcomes, and complications. In order to determine the quantitative impact of day case total shoulder arthroplasty on readmission and revision rate, a meta-analysis was performed on articles that observed 30- or 90-day readmission or revision.

Results

Eight articles were found to be suitable for inclusion in the present study which included 6103 day case total shoulder arthroplasty and 147,463 inpatient total shoulder arthroplasty. Following meta-analysis, there was no significant difference among patients who underwent day case total shoulder arthroplasty compared to inpatient total shoulder arthroplasty regarding revision rates (OR: 1.001; 95% CI: 0.721–1.389; p = 0.995) and 30-day readmission rates (OR: 0.940; 95% CI: 0.723–1.223; p = 0.646). In contrast, patients who underwent day case total shoulder arthroplasty were less likely to have a readmission within 90 days compared to their inpatient counterparts (OR: 0.839; 95% CI: 0.704–0.999; p = 0.049). Two out of eight studies reported comparable baseline clinical characteristics among groups, while five studies reported significant differences and one study did not provide information regarding clinical characteristics, such as medical comorbidities or American Society of Anaesthesiologists'(ASA) score. No significant difference among groups was found in all or almost all studies regarding mortality rates, and rates of cardiac complications, cerebrovascular events, thromboembolic events, pulmonary complications, cardiac complications, and nerve complications. Finally, results were rather conflicting regarding the correlation of day case total shoulder arthroplasty to the rate of surgical site infections.

Conclusions

This study showed that day case total shoulder arthroplasty might lead to similar rates of mortality, complications, revisions, and readmissions compared to inpatient total shoulder arthroplasty when used in a selected population of younger, healthier, and more male patients. In contrast, there was no consensus regarding the impact of day case total shoulder arthroplasty on the rate of surgical site infections. Finally, further research of higher quality is required to establish patient demographic criteria, ASA score, or comorbidity index cut off that might be used to define day case-treated patients who seem to have equivalent outcomes compared to inpatient-treated patients.

Level of evidence: Systematic review of level III studies (lowest level included).

Keywords

Total shoulder arthroplasty day case surgery ambulatory surgery rapid recovery glenohumeral arthritis meta-analysis

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References

Goldfarb

Bansal

Brophy

. Ambulatory surgical centers: a review of complications and adverse events. J Am Acad Orthop Surg 2017; 25: 12–22.

Mather

Wysocki

Mack Aldridge

, et al. Effect of facility on the operative costs of distal radius fractures. J Hand Surg Am 2011; 36: 1142–1148.

Nguyen

Milstein

Hernandez-Boussard

, et al. The effect of moving carpal tunnel releases out of hospitals on reducing United States health care charges. J Hand Surg Am 2015; 40: 1657–1662.

Robinson

Brown

Whaley

, et al. Consumer choice between hospital-based and freestanding facilities for arthroscopy: impact on prices, spending, and surgical complications. J Bone Joint Surg Am 2015; 97: 1473–1481.

Krell

Girotti

Dimick

. Extended length of stay after surgery: complications, inefficient practice, or sick patients? JAMA Surg 2014; 149: 815–815.

Padegimas

Maltenfort

Lazarus

, et al. Future patient demand for shoulder arthroplasty by younger patients: national projections. Clin Orthop Relat Res 2015; 473: 1860–1867.

Gregory

Wetzig

Wayne

, et al. Quantification of patient-level costs in outpatient total shoulder arthroplasty. J Shoulder Elbow Surg 2019; 28: 1066–1073.

Leroux

Basques

Frank

, et al. Outpatient total shoulder arthroplasty: a population-based study comparing adverse event and readmission rates to inpatient total shoulder arthroplasty. J Shoulder Elbow Surg 2016; 25: 1780–1786.

Lovett-Carter

Sayeed

Abaab

, et al. Impact of outpatient total joint replacement on postoperative outcomes. Orthop Clin North Am 2018; 49: 35–44.

10.

Fournier

Brolin

Azar

, et al. Identifying appropriate candidates for ambulatory outpatient shoulder arthroplasty: validation of a patient selection algorithm. J Shoulder Elbow Surg 2019; 28: 65–70.

11.

Oxford Centre for Evidence-based Medicine (CEBM). Levels of evidence (March 2009), http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/ (accessed 10 September 2018).

12.

Sambandam

Gul

Priyanka

. Analysis of methodological deficiencies of studies reporting surgical outcome following cemented total-joint arthroplasty of trapezio-metacarpal joint of the thumb. Int Orthop 2007; 31: 639–645.

13.

Arshi

Leong

Wang

, et al. Relative complications and trends of outpatient total shoulder arthroplasty. Orthopedics 2018; 41: e400–e409.

14.

Basques

Erickson

Leroux

, et al. Comparative outcomes of outpatient and inpatient total shoulder arthroplasty: an analysis of the Medicare dataset. Bone Joint J 2017; 99-B: 934–938.

15.

Bean

Connor

Schiffern

, et al. Outpatient shoulder arthroplasty at an Ambulatory Surgery Center using a multimodal pain management approach. J Am Acad Orthop Surg Glob Res Rev 2018; 2: e064–e064.

16.

Brolin

Mulligan

Azar

, 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 Surg 2017; 26: 204–208.

17.

Cancienne

Brockmeier

Gulotta

, et al. Ambulatory total shoulder arthroplasty: a comprehensive analysis of current trends, complications, readmissions, and costs. J Bone Joint Surg Am 2017; 99: 629–637.

18.

Gallay

Lobo

Baker

, et al. Development of a regional model of care for ambulatory total shoulder arthroplasty: a pilot study. Clin Orthop Relat Res 2008; 466: 563–572.

19.

Nwankwo

Dutton

Merriman

, et al. Outpatient total shoulder arthroplasty does not increase the 90-day risk of complications compared with inpatient surgery in prescreened patients. Orthopedics 2018; 41: e563–e568.