Summary

Patients who are above 70 years of age, use tobacco, and have ASA score of 3 may be less suitable for outpatient arthroplasty and should be counseled regarding the higher risk of unplanned overnight hospitalization.

Abstract

Introduction

With the COVID-19 pandemic placing an increased burden on healthcare systems, shoulder arthroplasties (TSA) are more commonly being performed as outpatient procedures. The purpose of this study was to characterize the 90-day episode-of-care complications of consecutive shoulder arthroplasties defaulted for outpatient surgery without using a prior algorithm for patient selection and to assess for their risk factors. We hypothesized that outpatient shoulder arthroplasty would be a safe procedure for all patients, regardless of patient demographics and comorbidities.

Methods

A retrospective review of consecutive patients who underwent planned outpatient anatomic or reverse total shoulder arthroplasty between March 2020 and January 2022 with 3-month follow-up was performed. All patients were scheduled for outpatient surgery regardless of medical comorbidities. Patient demographics, patient-reported outcomes (PROs) including visual analog scale (VAS), subjective shoulder value (SSV), and American Shoulder and Elbow score (ASES); range of motion (ROM); and complications were collected. Multivariate logistic regression was used to identify predictors of the following outcomes: 1. Unplanned overnight hospital stay, 2. 90-day unplanned ED/clinic visit, 3. 90-day hospital readmission, 4. 90-day complications requiring revision.

Results

127 patients (47% male, 17% tobacco users, 18% diabetics) with a mean age 69±9 years were identified, of whom 92 underwent reverse TSA (rTSA) and 35 underwent anatomic TSA (aTSA). All PROs and ROM were significantly improved at 3 months. There were 15 unplanned overnight hospital stays (11.8%) after the procedure. Within 90 days postoperatively, there were 17 unplanned ED/clinic visits (13.4%), 7 hospital readmissions (5.5%), and 4 complications requiring revision (3.1%). Surgical site infection occurred in 1 patient (0.8%), while deep vein thrombosis and pulmonary embolism occurred in 3 (2.4%) and 2 patients (1.6%), respectively.

Factors predictive of unplanned overnight stay included age above 70 years (OR, 36.80 [95% CI, 2.20-615.49]; p= 0.012), tobacco use (OR, 12.90 [95% CI, 1.23-135.31]; p= 0.033), and ASA status of 3 (OR, 13.84 [95% CI, 1.22-156.57]; p= 0.034). The only factor predictive of unplanned ED/clinic visit was age over 70 years old (OR, 7.52 [95% CI, 1.26-45.45]; p= 0.027). No factors were predictive of 90-day hospital readmission, or revision.

Conclusion

Outpatient shoulder arthroplasty is a safe procedure with excellent outcomes and low rates of readmissions and can be considered as the default plan for all patient undergoing shoulder arthroplasty. Patients who are above 70 years of age, use tobacco, and have ASA score of 3, however, may be less suitable for outpatient arthroplasty and should be counseled regarding the higher risk of unplanned overnight hospitalization.