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Outpatient total shoulder replacement: Pick the right patients, set the proper mindset

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KOLOA, Hawaii – With many compelling reasons for outpatient total shoulder replacement surgery, orthopedic surgeons need to be aware that one of the biggest factors for success is the mindset of the patients, said a presenter at Orthopedics Today Hawaii 2018, here.

“Some of outpatient surgery is the way we explain this to patients,” Mark A. Mighell, MD, said. “By doing this and by having a well-organized team, there are certain patients who would benefit greatly.”

Mark A. Mighell

Mighell said a successful outpatient total joint replacement program needs to have buy-in from multiple stakeholders. The programs also need centers of excellence; a dedicated shoulder team; established pathways for postoperative issues; cooperation from anesthesia and administration teams; and implant and vendor costs. Patient selection is also key, he said.

“Patient selection – this is where the rubber meets the road,” he said. “You have to pick the right patients.”

Studies have shown the best candidates are patients younger than 70 years, patients with a BMI of less than 35 kg/m² and the absence of significant cardiopulmonary comorbidities, he said. Patients must have private insurance, as outpatient shoulder replacement cannot be offered to patients with governmental insurance. Mighell said published studies have shown no significant differences in complications and no significant differences in readmission rates between properly selected patients. He also advised surgeons to have mechanisms in place to mitigate blood loss. Other critical issues are enhanced, pain control procedures and having the proper infrastructure to address postoperative management issues.

“You want to make sure your patient can get in touch with you,” he said. – by Kristine Houck, MA, ELS

Reference:

Mighell MA. Outpatient shoulder arthroplasty: How to ensure success and safety. Presented at: Orthopedics Today Hawaii 2018; Jan. 7-11, 2018; Koloa, Hawaii.

Disclosure: Mighell reports he receives royalties from NewClip Technics; is a consultant for and is on the speakers bureau for DJO Surgical and Stryker; and does contracted research for Stryker.