Outpatient shoulder arthroplasty: outcomes, complications, and readmissions in 2 outpatient settings
These authors reported their experience with outpatient shoulder arthroplasty including 90-day complications and readmissions in 50 consecutive patients (44 anatomic total shoulder arthroplasties, 4 reverse total shoulder arthroplasties, and 2 hemiarthroplasties). 18 had had a total of 28 prior surgeries, including 4 labral repairs, 2 Latarjets, 3 capsular shifts, 4 cuff repairs, 5 debridements, and 9 others.
These authors reported their experience with outpatient shoulder arthroplasty including 90-day complications and readmissions in 50 consecutive patients (44 anatomic total shoulder arthroplasties, 4 reverse total shoulder arthroplasties, and 2 hemiarthroplasties). 18 had had a total of 28 prior surgeries, including 4 labral repairs, 2 Latarjets, 3 capsular shifts, 4 cuff repairs, 5 debridements, and 9 others.
The average age was 56.9 6.9 years; average body mass index, 29.75 5.9; and average Charleston Comorbidity Index, 1.6 1.2.
All patients received an interscalene block for regional anesthesia (an indwelling catheter, used at the discretion of the surgeon, remained for 48-72 hours in most cases). All arthroplasties were performed through the deltopectoral interval, with 8 patients undergoing a tenotomy and 42 undergoing a subscapularis peel. Rehabilitation protocols varied based on surgeon and type of arthroplasty. In general, all patients were kept in a sling for 6 weeks, with HA and TSA patients allowed to perform Codman exercises and supervised limited passive range of motion with physical therapy, whereas RTSA patients were limited to Codman and basic home exercises. At 6 weeks, active range of motion was initiated, with strengthening at 12 weeks. RTSA patients received physical therapy at the discretion of the attending surgeon.
The average functional scores and ranges of motion were improved. There were 6 complications (12%) (hematoma, deep venous thrombosis, axillary nerve injury, acute infection, and 2 subscapularis failures). Four of these occurred within the 90-day global period, and only 1 patient required readmission. The subscapularis failures occurred after 3 months postoperatively and required additional surgery (arthroscopic repair and revision to reverse total shoulder arthroplasty).
Comment: These procedures were performed in the outpatient setting. These experienced surgeons carefully report the complications among 50 carefully selected patients. They observe that the key to safe and successful outpatient shoulder arthroplasty is patient selection, noting that complications, length of stay, and readmission rates increase with age, female sex, steroid use, and comorbidities (especially cardiac disease).
None of their complications appear to be related to the fact that these surgeries were performed in the outpatient setting.
=====
We have a new set of shoulder youtubes about the shoulder, check them out at this link.
Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link
Use the "Search" box to the right to find other topics of interest to you.
You may be interested in some of our most visited web pages arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
