Outpatient shoulder replacement surgery seen as safe as inpatient surgery

BOSTON — Shoulder replacement performed in the outpatient setting is as safe as it is performed in the inpatient setting, according to results presented at the American Shoulder and Elbow Surgeons Annual Meeting.

“[I]nitial data suggest that it is safe in comparison to inpatient to perform these surgeries as an outpatient, but we need to refine the indications. Larger cohorts are required and longer time follow-up [is needed] to document efficacy and safety, and we need our payers to accept this,” Nikhil N. Verma, MD, said in his presentation.

Using the American College of Surgeons National Surgical Quality Improvement Program database between 2005 and 2014, Verma and colleagues identified patients who underwent either inpatient or outpatient primary shoulder replacement.

“We defined the outpatient cohort as length of stay of 0 days with discharge in the same calendar day,” Verma said. Of more than 7,000 patients identified, 173 patients underwent outpatient surgery.

“You can see they tended to be younger patients. They tended to be males, were healthier, had a lower BMI and generally underwent general anesthetic,” Verma said.

He noted a 2.3% rate of overall adverse events and a 1.7% rate of readmission in the outpatient group compared with 7.9% and 2.9%, respectively, in the inpatient group.

“When we performed a multivariate analysis, we found there was a trend toward decreased adverse events in the outpatient group — although it did not quite reach statistical significance — and there was no difference in readmissions between the two groups,” Verma said. “Overall, there was no difference in the rates of adverse events between the outpatient and inpatient setting and we believe that ultimately in the appropriately selected patient that outpatient total shoulder arthroplasty is at least as safe as in the inpatient environment.” – by Casey Tingle

Reference:

Leroux TS, et al. Paper #21. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 7-9, 2016; Boston.

Disclosure: Verma reports no relevant financial disclosures.