Day case shoulder arthroplasty: needed now more than ever

2021 ◽  
pp. 1-7
Author(s):  
Tanujan Thangarajah
Keyword(s):  
Shoulder Arthroplasty ◽  
Waiting Times ◽  
Total Shoulder Arthroplasty ◽  
Cost Savings ◽  
Team Approach ◽  
Ageing Population ◽  
Day Case ◽  
Safe Alternative ◽  
Joint Replacement Surgery ◽  
Replacement Surgery

The demand for total shoulder arthroplasty has grown over the years and is set to continue in a similar trend because of the ageing population. Following a global reduction in elective orthopaedic treatment and an exponential rise in surgical waiting times, innovative strategies are desperately needed to mitigate against the harmful effects of delaying vital operations on both patients and the wider society. Day case shoulder arthroplasty is a safe alternative to a traditional inpatient approach, with evidence supporting substantial cost savings, improved outcomes and fewer complications. Rigorous patient selection and a multidisciplinary team approach are paramount when adopting a day case service to deliver joint replacement surgery. This review outlines the principles of day case total shoulder arthroplasty and highlights key considerations when transitioning to this approach.

Outcomes of day case shoulder replacement surgery in a stand-alone day care unit in the United Kingdom

2022 ◽  
pp. 175857322110708
Author(s):  
Mosab Elgalli ◽  
Jamie Hind ◽  
Ian Lahart ◽  
Gur Aziz Singh Sidhu ◽  
Sajjad Athar ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Care Pathway ◽  
Surgical Care ◽  
Operation Time ◽  
District General Hospital ◽  
Shoulder Replacement ◽  
Day Case ◽  
Replacement Surgery ◽  
Post Surgery ◽  
Significant Difference

Background: This review aims to compare the outcomes for day case shoulder replacement with in-patient shoulder replacement surgery in a district general hospital. Methods: Seventy-three patients had 82 shoulder arthroplasty procedures. Forty-six procedures were undertaken in a dedicated stand-alone day-case unit and 36 were undertaken as in-patient cases. Patient were followed up at 6 weeks, 6 months and annually. Results: There was no significant difference between the outcomes of shoulder arthroplasty procedures performed in the day case or in-patient settings making this a safe option for surgical care in a unit with an appropriate care pathway. Six complications in total were observed, three in each group. Operation time was statistically shorter for day cases by 25.1 min (95% CI - 36.5 to −13.7; d = −0.95, 95% CI −1.42 to 0.48). Estimated marginal means (EMM) revealed lower post-surgery oxford pain scores in day cases (EMM = 3.25, 95% CI 2.35, 4.16) compared with inpatients (EMM = 4.65, 95% CI 3.64 to 5.67). Constant shoulder scores were higher in day cases versus inpatients. Conclusion: Day case shoulder replacement is safe with comparable outcomes to routine inpatient care for patients up to ASA 3 classification with high satisfaction and excellent functional outcomes.

Bundled Payment Plans Are Associated With Notable Cost Savings for Ambulatory Outpatient Total Shoulder Arthroplasty

2019 ◽  
Vol 28 (19) ◽  
pp. 795-801
Author(s):  
Jordan D. Walters ◽  
Ryan N. Walsh ◽  
Richard A. Smith ◽  
Tyler J. Brolin ◽  
Frederick M. Azar ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Cost Savings ◽  
Bundled Payment

scholarly journals Outpatient Shoulder Arthroplasty—A Systematic Review

2021 ◽  
Vol 5 ◽  
pp. 247154922110280
Author(s):  
Sachin Allahabadi ◽  
Edward C Cheung ◽  
Jonathan D Hodax ◽  
Brian T Feeley ◽  
Chunbong B Ma ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
Shoulder Arthroplasty ◽  
Management Strategies ◽  
Cost Savings ◽  
Single Shot ◽  
Safe Alternative ◽  
High Satisfaction ◽  
Inpatient Management ◽  
Surgeon Satisfaction

Objective Recent reports have shown that outpatient shoulder arthroplasty (SA) may be a safe alternative to inpatient management in appropriately selected patients. The purpose was to review the literature reporting on outpatient SA. Methods A systematic review of publications on outpatient SA was performed. Included publications discussed patients who were discharged on the same calendar day or within 23 hours from surgery. Articles were categorized by discussions on complications, readmissions, and safety, patient selection, pain management strategies, cost effectiveness, and patient and surgeon satisfaction. Results Twenty-six articles were included. Patients undergoing outpatient SA were younger and with a lower BMI than those undergoing inpatient SA. Larger database studies reported more medical complications for patients undergoing inpatient compared to outpatient SA. Articles on pain management strategies discussed both single shot and continuous interscalene blocks with similar outcomes. Both patients and surgeons reported high levels of satisfaction following outpatient SA, and cost analysis studies demonstrated significant cost savings for outpatient SA. Conclusion In appropriately selected patients, outpatient SA can be a safe, cost-saving alternative to inpatient care and may lead to high satisfaction of both patients and physicians, though further studies are needed to clarify appropriate utilization of outpatient SA.

scholarly journals Day case versus inpatient total shoulder arthroplasty: A retrospective cohort study and cost-effectiveness analysis

2020 ◽  
Author(s):  
Aditya Borakati ◽  
Asad Ali ◽  
Chetana Nagaraj ◽  
Srinivas Gadikoppula ◽  
Michael Kurer
Keyword(s):  
Cohort Study ◽  
Cost Effectiveness ◽  
Adverse Events ◽  
Retrospective Cohort Study ◽  
Shoulder Arthroplasty ◽  
Retrospective Cohort ◽  
Total Shoulder Arthroplasty ◽  
Mean Difference ◽  
Day Case ◽  
Significant Cost

AbstractBackgroundDay case total shoulder arthroplasty (TSA) is a novel approach, not widely practiced in Europe. We conducted a retrospective cohort study of patients comparing elective day case and inpatient TSAs in our UK centre.AimTo evaluate the efficacy and cost-effectiveness of day case total shoulder arthroplasty (TSA) compared to standard inpatient total shoulder arthroplasty.MethodsAll patients undergoing TSA between January 2017 and July 2018 were included. Outcome measures were: change in abduction and extension 3 months postoperatively; 30 day postoperative adverse events and re-admissions in day case and inpatient groups. We also conducted an economic evaluation of outpatient arthroplasty. Multivariate linear and logistic regression were used to adjust for demographic and operative covariates.Results59 patients were included, 18 day cases and 41 inpatients. There were no adverse events or re-admissions at 30 days postoperatively in either group. There were no significant differences in adjusted flexion (mean difference 16.4°; 95% CI -17.6° to 50.5°, p=0.337) or abduction (mean difference 13.2° 95% CI; -18.4° to 44.9°, p=0.405) postoperatively between groups. Median savings with outpatient arthroplasty were GBP 529 (IQR 247.33 to 789, p<0.0001).ConclusionDay case TSA is a safe, effective procedure, with significant cost benefit. Wider use may be warranted in the UK and beyond, with potential for significant cost savings and improved efficiency.Core tipIn this article we show that day case total shoulder arthroplasty is a feasible, safe and effective alternative to inpatient admission for the same procedure, with an associated average cost saving of GBP 529.

Day case versus inpatient total shoulder arthroplasty: A systematic review and meta-analysis

2020 ◽  
pp. 175857322094441
Author(s):  
Michael-Alexander Malahias ◽  
Stefania Kokkineli ◽  
Alex Gu ◽  
Dimitris Karanikas ◽  
Scott G Kaar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Shoulder Arthroplasty ◽  
Clinical Characteristics ◽  
Meta Analysis ◽  
Total Shoulder Arthroplasty ◽  
Surgical Site Infections ◽  
Cardiac Complications ◽  
Day Case ◽  
Significant Difference

Background A number of papers have been published comparing the safety and efficacy of day case and inpatient anatomic or reverse total shoulder arthroplasty. However, no systematic review of the literature has been published to date. The aim of this review was to determine if day case total shoulder arthroplasty (length of stay <24 h) leads to similar outcomes as standard-stay inpatients (length of stay ≥24 h). Methods The US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviewers were queried for publications utilizing keywords that were pertinent to total shoulder arthroplasty, day case, outpatient and inpatient, clinical or functional outcomes, and complications. In order to determine the quantitative impact of day case total shoulder arthroplasty on readmission and revision rate, a meta-analysis was performed on articles that observed 30- or 90-day readmission or revision. Results Eight articles were found to be suitable for inclusion in the present study which included 6103 day case total shoulder arthroplasty and 147,463 inpatient total shoulder arthroplasty. Following meta-analysis, there was no significant difference among patients who underwent day case total shoulder arthroplasty compared to inpatient total shoulder arthroplasty regarding revision rates (OR: 1.001; 95% CI: 0.721–1.389; p = 0.995) and 30-day readmission rates (OR: 0.940; 95% CI: 0.723–1.223; p = 0.646). In contrast, patients who underwent day case total shoulder arthroplasty were less likely to have a readmission within 90 days compared to their inpatient counterparts (OR: 0.839; 95% CI: 0.704–0.999; p = 0.049). Two out of eight studies reported comparable baseline clinical characteristics among groups, while five studies reported significant differences and one study did not provide information regarding clinical characteristics, such as medical comorbidities or American Society of Anaesthesiologists'(ASA) score. No significant difference among groups was found in all or almost all studies regarding mortality rates, and rates of cardiac complications, cerebrovascular events, thromboembolic events, pulmonary complications, cardiac complications, and nerve complications. Finally, results were rather conflicting regarding the correlation of day case total shoulder arthroplasty to the rate of surgical site infections. Conclusions This study showed that day case total shoulder arthroplasty might lead to similar rates of mortality, complications, revisions, and readmissions compared to inpatient total shoulder arthroplasty when used in a selected population of younger, healthier, and more male patients. In contrast, there was no consensus regarding the impact of day case total shoulder arthroplasty on the rate of surgical site infections. Finally, further research of higher quality is required to establish patient demographic criteria, ASA score, or comorbidity index cut off that might be used to define day case-treated patients who seem to have equivalent outcomes compared to inpatient-treated patients. Level of evidence: Systematic review of level III studies (lowest level included).

Quantification of cost savings from outpatient total shoulder arthroplasty

2019 ◽  
Vol 28 (6) ◽  
pp. e208
Author(s):  
James M. Gregory ◽  
Alexander M. Wetzig ◽  
Colton D. Wayne ◽  
Ryan J. Warth ◽  
Lane Bailey
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Cost Savings

scholarly journals Multimodality imaging in shoulder arthroplasties Part 2: Immediate pre- and intra-operative imaging and imaging of early and late complications – A pictorial review

2021 ◽  
Vol 0 ◽  
pp. 1-6
Author(s):  
Matthew Sarvesvaran ◽  
Suresh Srinivasan ◽  
Rahatdeep Singh Brar ◽  
Raj Bhatt ◽  
Harun Gupta ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Shoulder Arthroplasty ◽  
Multimodality Imaging ◽  
Surgical Techniques ◽  
Nuclear Imaging ◽  
Late Complications ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Pictorial Review ◽  
Shoulder Arthroplasties

Shoulder arthroplasty imaging requires a thorough understanding of surgical techniques, biomechanics involved during and after the joint replacement surgery and complications unique to shoulder arthroplasties. One may believe that imaging of complications requires excessive complex imaging modalities such as MRI or nuclear imaging. However, contrary to such beliefs, one can diagnose such complications mostly on radiographs. We will describe advances in immediate pre-operative imaging and utility of imaging to diagnose shoulder arthroplasty- related complications in part 2 of our two-part pictorial review series.

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