Outpatient shoulder arthroplasty - when is it a good idea?

Appropriate Patient Selection for Outpatient Shoulder Arthroplasty: A Risk Prediction Tool

These authors sought to develop a predictive model for patient discharge by postoperative day 0 or 1.

They used a multi-center cohort of 5,410 shoulder arthroplasties (2,805 anatomics, 2,605 reverses) from two geographically diverse, high-volume health systems.

2,238 (41.4%) patients were discharged at least by postoperative day 1, with no difference in rates of 90-day readmission (3.5% vs 3.3%) between short and extended length of stay (discharge after postoperative day 1).  True same-day discharge occurred in 3.9% of cases. Nine percent overall were discharged to a skilled nursing or rehab facility (anatomic: 5.9%, reverse: 12.3%, p < 0.001).

A multivariable logistic regression model demonstrated high accuracy (AUC: 0.762) for discharge by postoperative day 1, and was composed of 13 variables: surgery duration, age, gender, electrolyte disorder, marital status, ASA,  paralysis, diabetes, neurologic disease, peripheral vascular disease, pulmonary circulation disease, cardiac arrhythmia, and coagulation deficiency. The relative importance of each of these factors is shown below.

The predictive model was incorporated into an online tool  (see this link).

The two figures below show the predictions for two hypothetical patients who are identical except for one having a spouse/partner (blue) and the other having no partner or spouse (black), the latter have a 3X greater likelihood of discharge to SNF/Rehab.

Comment: While this study sought to determine preoperative predictors of length of stay >1 postoperative day, the strongest predictor was the duration of surgery - a value not known prior to admission. The model has yet to be validated as a predictor for same day discharge after arthroplasty.

In our practice the most important elements in planning same day discharge after arthroplasty are (1) a patient who is sufficiently healthy, robust and informed to leave the hospital on the day of surgery, 2) a support person who will be with the patient at discharge and for a few post discharge days, (3) comprehensive preoperative discussion with the patient and their support person to set expectations,  (4)  a robust plan for pain management, and (5) explicit contact information for a member of the surgical team who can be contacted in the event of questions or problems.

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Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link)

The smooth and move for irreparable cuff tears (see this link)

The total shoulder arthroplasty (see this link).

The ream and run technique is shown in this link.

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).

Shoulder rehabilitation exercises (see this link).

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Note that author has no financial relationships with any orthopaedic companies.