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Elgalli M, Hind J, Lahart I, Sidhu GAS, Athar S, Ashwood N. Outcomes of day case shoulder replacement surgery in a stand-alone day care unit in the United Kingdom. Shoulder Elbow 2023; 15:300-310. [PMID: 37325392 PMCID: PMC10268143 DOI: 10.1177/17585732211070822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/02/2021] [Accepted: 12/13/2021] [Indexed: 09/20/2023]
Abstract
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.
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Affiliation(s)
- Mosab Elgalli
- University Hospital Derby and Burton, Belvedere Rd, Burton-on-Trent, UK
| | - Jamie Hind
- University Hospital Derby and Burton, Belvedere Rd, Burton-on-Trent, UK
| | - Ian Lahart
- University of Wolverhampton, Gorway Road, Walsall, UK
| | | | - Sajjad Athar
- University Hospital Derby and Burton, Belvedere Rd, Burton-on-Trent, UK
| | - Neil Ashwood
- University Hospital Derby and Burton, Belvedere Rd, Burton-on-Trent, UK
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Allen J, Abdelmonem M, Fieraru G, Guyver P. Introducing A Day-Case Shoulder Arthroplasty Pathway In The UK - How We Did It. Shoulder Elbow 2023; 15:311-320. [PMID: 37325384 PMCID: PMC10268136 DOI: 10.1177/17585732221079582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 09/20/2023]
Abstract
Background As the demand for elective orthopaedics grows, day-case arthroplasty is gaining popularity. The aim of this study was to create a safe and reproducible pathway for day-case shoulder arthroplasty (DCSA) based upon a literature review and discussion with the local multidisciplinary team (MDT). Methods A literature review was performed using OVID MEDLINE and Embase databases reporting 90-day complication and admission rates following DCSA. Minimum follow-up was 30 days. Day-case was defined as discharge on the same day of surgery. Results The literature review revealed a mean 90-day complication rate of 7.7% [range, 0-15.9%] and mean 90-day readmission rate of 2.5% [range 0-9.3%]. A pilot protocol was devised based upon the literature review and consisted of 5 phases: (1) pre-operative assessment, (2) intra-operative phase, (3) post-operative phase, (4) follow-up, and (5) readmission protocol. This was presented, discussed, amended, and ultimately ratified by the local MDT. In May 2021 the unit successfully completed its first day-case shoulder arthroplasty. Discussion This study proposes a safe and reproducible pathway for DCSA. Patient selection, well-defined protocols and communication within the MDT are important factors to achieve this. Further studies with extended follow-up will be needed to gauge long-term success within our unit.
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Affiliation(s)
- James Allen
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Huddersfield, UK
- Huddersfield Royal Infirmary, Huddersfield, UK
| | - Mohamed Abdelmonem
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Huddersfield, UK
| | - Gabriel Fieraru
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Huddersfield, UK
| | - Paul Guyver
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Huddersfield, UK
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Galvin JW, Kim R, Ment A, Durso J, Joslin PMN, Lemos JL, Novikov D, Curry EJ, Alley MC, Parada SA, Eichinger JK, Li X. Outcomes and complications of primary reverse shoulder arthroplasty with minimum of 2 years' follow-up: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31:e534-e544. [PMID: 35870805 DOI: 10.1016/j.jse.2022.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/26/2022] [Accepted: 06/05/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Primary reverse shoulder arthroplasty (rTSA) is an effective treatment option for reducing pain and improving function for patients with rotator cuff tear arthropathy, irreparable rotator cuff tears, glenoid deformity, and other challenging clinical scenarios, including fracture sequelae and revision shoulder arthroplasty. There has been a wide range of reported outcomes and postoperative complication rates reported in the literature. The purpose of this systematic review and meta-analysis is to provide an updated review of the clinical outcomes and complication rates following primary rTSA. METHODS A systematic review and meta-analysis was performed to evaluate outcomes and complications following primary rTSA according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Demographics, range of motion, patient-reported outcome measures (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES] and Constant scores), number of complications, and revisions were extracted, recorded, and analyzed from the included articles. RESULTS Of the 1415 studies screened, 52 studies met the inclusion criteria comprising a total of 5824 shoulders. The mean age at the time of surgery was 72 years (range: 34-93), and the mean follow-up was 3.9 years (range: 2-16). Patients demonstrated a mean improvement of 56° in active flexion, 50° in active abduction, and 14° in active external rotation. Regarding functional outcome scores, rTSA patients demonstrated a mean clinically significant improvement of 37 in Constant score (minimal clinically important difference [MCID] = 5.7) and ASES score (42.0; MCID = 13.6). The overall complication rate for rTSA was 9.4% and revision rate of 2.6%. Complications were further subdivided into major medical complications (0.07%), shoulder- or surgical-related complications (5.3%), and infections (1.2%). The most frequently reported shoulder- or surgical-related complications were scapular notching (14.4%), periprosthetic fracture (0.8%), glenoid loosening (0.7%), and prosthetic dislocation (0.7%). DISCUSSION Primary rTSA is a safe and reliable procedure with low complication, revision, infection, and scapular notching rates. Additionally, patients demonstrated clinically significant improvements in both range of motion and clinical outcome scores.
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Affiliation(s)
| | - Ryan Kim
- Boston University School of Medicine, Boston, MA, USA
| | - Alexander Ment
- The University of Connecticut School of Medicine, Farmington, CT, USA
| | | | | | | | - David Novikov
- Boston University School of Medicine, Boston, MA, USA
| | - Emily J Curry
- Boston University School of Medicine, Boston, MA, USA
| | | | | | | | - Xinning Li
- Boston University School of Medicine, Boston, MA, USA.
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Sandler AB, Scanaliato JP, Narimissaei D, McDaniel LE, Dunn JC, Parnes N. The transition to outpatient shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 2022; 31:e315-e331. [PMID: 35278682 DOI: 10.1016/j.jse.2022.01.154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Transitioning shoulder arthroplasty (SA) from an inpatient to outpatient procedure is associated with increased patient satisfaction and potentially decreased costs; however, concerns exist about complications following same-day discharge. We hypothesized that outpatient SA would be associated with low rates of failed discharges, readmissions, and complications, rendering it a safe and effective option for SA. METHODS A systematic review of the outpatient SA literature identified 16 of 447 studies with level III and IV evidence that met the inclusion criteria with at least 90 days of follow-up. Data on patient demographic characteristics, preoperative and postoperative protocols, surgery characteristics, failed discharges, complications, and readmissions were collected and pooled for analysis. RESULTS A total of 990 patients were included in our analysis. Many studies identified specific institutional protocols for determining eligibility for outpatient SA, including preoperative clearance from an anesthesiologist; identification of a perioperative caretaker; and exclusion of patients based on cardiac, pulmonary, or hematologic risk factors. Failed same-day discharge occurred in only 0.9% of patients (7 of 788), and 2.1% of patients (9 of 418) and 0.79% of patients (2 of 252) presented to an emergency department or urgent care facility for a perioperative concern. The readmission rate for periprosthetic fracture, arthrofibrosis, infection, subscapularis rupture, and anterior subluxation was 1.3% (7 of 529 patients). Complications occurred in 7.0% of patients (70 of 990), with 5.4% of patients (53 of 990) experiencing a surgical complication and 1.7% (17 of 990) having a medical complication. There were 28 total reoperations (2.9%, 28 of 955 patients). DISCUSSION AND CONCLUSION Outpatient SA is associated with low rates of failed discharges, readmissions, and complications. Additionally, the medical and surgical complications that occur after outpatient SA are unlikely to be prevented by the short inpatient stay characteristic of traditional SA. With careful screening measures to identify appropriate candidates for same-day discharge, outpatient SA represents a safe approach to prevent unnecessary hospitalizations and to decrease costs associated with SA.
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Affiliation(s)
- Alexis B Sandler
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA.
| | - John P Scanaliato
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Danielle Narimissaei
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Lea E McDaniel
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - John C Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, NY, USA; Department of Orthopaedic Surgery, Claxton-Hepburn Medical Center, Ogdensburg, NY, USA
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Allahabadi S, Cheung EC, Hodax JD, Feeley BT, Ma CB, Lansdown DA. Outpatient Shoulder Arthroplasty-A Systematic Review. J Shoulder Elb Arthroplast 2022; 5:24715492211028025. [PMID: 34993380 PMCID: PMC8492032 DOI: 10.1177/24715492211028025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/07/2021] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Sachin Allahabadi
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Edward C Cheung
- Department of Orthopaedic Surgery, University of California, Los Angeles, California
| | - Jonathan D Hodax
- Department of Orthopaedic Surgery, Virginia Mason Medical Center, Virginia Mason Medical Center, Seattle, Washington
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Chunbong B Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, California
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Stolberg-Stolberg J, Köppe J, Rischen R, Freistühler M, Faldum A, Katthagen JC, Raschke MJ. [Influence of complications and comorbidities on length of hospital stay and costs for surgical treatment of proximal humeral fractures]. Chirurg 2021; 92:907-915. [PMID: 34533598 PMCID: PMC8463392 DOI: 10.1007/s00104-021-01491-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 11/30/2022]
Abstract
Nach proximaler Humerusfraktur beim alten Patienten stellen die winkelstabile Plattenosteosynthese und die inverse Schulterendoprothese zwei konkurrierende Operationsverfahren dar. Auch wenn erste klinische Studien auf eine funktionelle Überlegenheit der inversen Schulterendoprothese hindeuten, fehlt ein gesundheitsökonomischer Vergleich in der Literatur. Krankenkassendaten von 55.070 Patienten ab einem Alter von 65 Jahren, welche nach proximaler Humerusfraktur mittels inverser Schulterendoprothese oder winkelstabiler Plattenosteosynthese versorgt worden sind, wurden auf Kosten und Liegedauer untersucht. Multivariable lineare Regressionsmodelle wurden zur Beurteilung von Komplikationen und Komorbiditäten gerechnet. Die Liegedauer nach inverser Schulterendoprothese war mit 20,0 (±13,5) Tagen statistisch auffällig länger als nach winkelstabiler Plattenosteosynthese mit 14,6 (±11,4) Tagen (p < 0,001). Die Kosten pro Fall unterschieden sich mit 11.165,70 (±5884,36) EUR für die inverser Prothese und 7030,11 (±5532,02) EUR für die Plattenosteosynthese deutlich (p < 0,001). Statistisch auffällige Kostensteigerungen durch Komplikationen und Komorbiditäten unterstreichen den Bedarf an spezialisierten geriatrischen Traumazentren.
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Affiliation(s)
- Josef Stolberg-Stolberg
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude W1, 48149, Münster, Deutschland.
| | - Jeanette Köppe
- Institut für Biometrie und Klinische Forschung, Westfälische Wilhelms-Universität Münster, Schmeddingstraße 56, 48149, Münster, Deutschland
| | - Robert Rischen
- Klinik für Radiologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
| | - Moritz Freistühler
- Geschäftsbereich Medizinisches Management-Medizincontrolling, Universitätsklinikum Münster, Niels-Stensen-Straße 8, 48149, Münster, Deutschland
| | - Andreas Faldum
- Institut für Biometrie und Klinische Forschung, Westfälische Wilhelms-Universität Münster, Schmeddingstraße 56, 48149, Münster, Deutschland
| | - J Christoph Katthagen
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude W1, 48149, Münster, Deutschland
| | - Michael J Raschke
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude W1, 48149, Münster, Deutschland
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Cointat C, Gauci MO, Azar M, Tran L, Trojani C, Boileau P. Outpatient shoulder prostheses: Feasibility, acceptance and safety. Orthop Traumatol Surg Res 2021; 107:102913. [PMID: 33798792 DOI: 10.1016/j.otsr.2021.102913] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 10/11/2020] [Accepted: 10/26/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Outpatient surgery in France is defined by the national authority for health (HAS) as a scheduled surgery enabling same-day discharge without any increased risk to the patient. With the advent of enhanced recovery after surgery, outpatient lower limb arthroplasty has become a common procedure. However, only 1.1% of knee arthroplasties in France were performed on an outpatient basis in 2017. OBJECTIVES 1) assess early morbidity and mortality after outpatient shoulder arthroplasties to validate eligibility and safety criteria; and 2) assess patient acceptance of outpatient surgery. METHODS A single-center study with the following inclusion criteria: primary shoulder arthroplasty, American Society of Anesthesiology (ASA) score I or II, no cognitive impairment, and no coronary artery or thromboembolic diseases. Analgesia was provided by bupivacaine via a peripheral nerve catheter in the first 72 hours followed by oral analgesics. Patients were discharged if the post-anesthetic discharge scoring system (PADSS) was>9/10 and the visual analog scale (VAS) was<5/10. Postoperative telephone interviews were carried out on D1, D2 and D3 to assess pain with the numerical rating scale and to collect data on their analgesic consumption. All patients were seen by an independent observer at one and six months for a clinical and radiologic follow-up and at 90 days during a consultation with the senior surgeon. The primary endpoint was the 90-day morbidity and mortality rate (readmissions, rehospitalizations, and minor and major complications). A satisfaction questionnaire was collected at one and six months. RESULTS Thirty-six patients were offered an outpatient shoulder arthroplasty between February 2016 and February 2018: 12 (33%) refused with no valid reasons and 24 patients agreed to the procedure (seven hemiarthroplasties, nine anatomic shoulder arthroplasties and eight reverse shoulder arthroplasties). The mean age at surgery was 70 years (55-82), mean body mass index (BMI) was 26 (21-32) and 14 patients were ASA II (66%). Three patients (12%) refused same-day discharge despite a PADSS score>9/10 and adequate pain management. Two patients (8%) were not discharged home on the same day as the surgery for medical reasons (one for pain and one for high blood pressure). No readmissions or complications were reported for the 19 outpatient arthroplasties. None of the outpatients used opioids. All patients were satisfied with their functional outcome, 84% were satisfied with the outpatient management and 17% felt they were insufficiently monitored and regretted that they were not hospitalized. CONCLUSIONS 1) outpatient shoulder arthroplasty can be safely proposed to selected patients with low comorbidities, regardless of their age and type of implant; 2) the acceptance rate for outpatient shoulder arthroplasty remained low among our patient population. These results should incite us to better educate patients about outpatient surgery. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Caroline Cointat
- Unité de recherche clinique Côte d'Azur (UR2CA), service de chirurgie orthopédique et chirurgie du sport, institut universitaire locomoteur et du sport (iULS), CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Marc Olivier Gauci
- Unité de recherche clinique Côte d'Azur (UR2CA), service de chirurgie orthopédique et chirurgie du sport, institut universitaire locomoteur et du sport (iULS), CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Michel Azar
- Unité de recherche clinique Côte d'Azur (UR2CA), service de chirurgie orthopédique et chirurgie du sport, institut universitaire locomoteur et du sport (iULS), CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Laurie Tran
- Service d'anesthésie-réanimation, institut Arnault-Tzanck, 171, rue du Commandant Gaston-Cahuzac, 06700 Saint-Laurent-du-Var, France
| | - Christophe Trojani
- Unité de recherche clinique Côte d'Azur (UR2CA), service de chirurgie orthopédique et chirurgie du sport, institut universitaire locomoteur et du sport (iULS), CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France; Groupe Kantys, institut de chirurgie réparatrice locomoteur et du sport (ICR), 7, avenue Durante, 06000 Nice, France
| | - Pascal Boileau
- Unité de recherche clinique Côte d'Azur (UR2CA), service de chirurgie orthopédique et chirurgie du sport, institut universitaire locomoteur et du sport (iULS), CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France.
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