Trends in outpatient versus inpatient total shoulder arthroplasty over time
Nabil Mehta, MD; Daniel D. Bohl, MD, MPH; Matthew R. Cohn, MD; Johnathon R. McCormick, MD; Gregory P. Nicholson, MD; Grant E. Garrigues, MD; Nikhil N. Verma, MD
Full length article · Volume 6, Issue 1, Pages 7–14, January 2022
Background
The question this study asked
Total shoulder replacement has moved steadily toward same-day discharge, and this study set out to examine how safe the outpatient and inpatient versions of the procedure are, and whether that safety picture has shifted over time.
Methods
How the study was conducted
The authors identified patients who underwent primary total shoulder arthroplasty between 2006 and 2019 through the American College of Surgeons National Surgical Quality Improvement Program. Those patients were split into an early group covering 2006 to 2016, made up of 12,401 patients, and a late group covering 2017 to 2019, made up of 12,845 patients. Any procedure where the patient went home on the day of surgery counted as outpatient. Comorbidities and the rate of adverse events within 30 days of surgery were compared across groups, with standard multivariate regression used to adjust for differences in baseline characteristics.
Results
What the measurements showed
Looking at all cases together, complications fell meaningfully over time, from 5.69 percent in the early group to 3.67 percent in the late group. That decline was driven by inpatients, whose complication rate dropped from 5.80 percent to 3.90 percent. Among outpatients, the rate did not change significantly, moving from 1.98 percent to 1.38 percent. In both time periods, inpatients had significantly more complications than outpatients. Patient demographics also shifted: total shoulder arthroplasty became more common in patients over 70 in both the inpatient and outpatient groups, while fewer patients aged 18 to 59 underwent the procedure in the later period.
Conclusion
What it means
The overall complication rate for total shoulder arthroplasty has fallen as the outpatient version of the procedure has become more common. Examined more closely, the contemporary data show the outpatient complication rate holding steady while the inpatient rate improved, and this happened even as the profile of patients receiving the surgery changed. Outpatient total shoulder arthroplasty has stayed a safe procedure as selection criteria have evolved, and the safety of the inpatient procedure continues to improve.
