These authors queried a national insurance database for patients who underwent anatomic total shoulder arthroplasty between the fourth quarter of 2010 and 2014, comparing 706 patients undergoing ambulatory total shoulder arthroplasty to a matched group of patients undergoing inpatient total shoulder arthroplasty.
They found no statistically different complication rates or rates of readmission between the two groups. The patients undergoing ambulatory total shoulder arthroplasty had significantly lower costs (p <0.0001) at $14,722 compared with the matched controls at $18,336 in numerous itemized cost categories as well as costs related to diagnosis-related groups.
Comments: While this retrospective study of an insurance database demonstrated that ambulatory shoulder arthroplasty can result in cost savings, this study did not clarify the selection criteria for such procedures nor the particular infrastructure elements necessary to support patients having outpatient arthroplasty. The safe conduct of ambulatory shoulder arthroplasty would seem to depend on the 24/7 availability of qualified support for patients in the event of bleeding, unexpected pain, urinary retention and other medical and surgical complications.
Of interest is the factors associated with readmission after either inpatient or ambulatory arthroplasty.
It is clear that patient safety and economics are more dependent on these factors than in which setting the surgery is done.
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