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Outpatient, inpatient TSA yielded similar complication profiles at 1-year follow-up
Research should help identify ideal patients for outpatient TSA beyond young, healthy individuals.
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Results published in Orthopedics showed outpatient total shoulder arthroplasty was safe and effective when it was performed in a select patient population, and it has the potential to decrease payer cost compared with inpatient total shoulder arthroplasty.
“Outpatient total shoulder arthroplasty has a comparable complication rate to inpatient total shoulder arthroplasty and can be considered an alternative to inpatient arthroplasty,” Frank A. Petrigliano, MD, associate professor of orthopedic surgery in the department of orthopedic surgery at University of California, Los Angeles, told Orthopedics Today.
Through a review of a national administrative claims database, Petrigliano and his colleagues categorized patients undergoing either anatomic or reverse total shoulder arthroplasty (TSA) into an inpatient (n=15,987) or outpatient (n=1,555) group. Researchers used ICD-9 and CPT codes to determine the incidence of perioperative surgical and medical complications for both groups.
Across the study period of 2007 to 2016, results showed a statistically significant increase in the incidence of inpatient and outpatient TSA. Researchers found stiffness requiring manipulation under anesthesia (MUA), revision arthroplasty, infection requiring irrigation and debridement/arthrotomy and shoulder dislocation were the most common complications among both groups at 1 year postoperatively. However, the outpatient group had a significantly lower incidence of stiffness requiring MUA at 6 months, as well as at 1 year when adjustment was done for age, sex and Charlson Comorbidity Index using multivariate logistic regression. Researchers reported a significantly greater incidence of postoperative surgical site infections that required irrigation and debridement/arthrotomy among outpatients at 6 months and 1 year.
Results showed the two groups had comparable rates of all other postoperative complications.
“There was a slightly increased risk of infection in the outpatient group and there was a slightly increased risk of need for manipulation under anesthesia in the inpatient group but, overall, the complication profiles were similar between the inpatient and outpatient total shoulder arthroplasty groups,” Petrigliano said.
One surprising finding, Petrigliano noted, was outpatient TSA being performed in young, healthy patients and in older patients, as well.
“If you look at the two groups, there [are] just as many outpatient total shoulders being done in the older age group, so that would be 65 to 75 [years] and 75 to 80 [years], as the inpatient group, relatively speaking,” Petrigliano said.
Future research should help identify patients who should not undergo TSA in the outpatient setting, he said.
“The one advantage of shoulder replacement relative to hip and knee replacement is it is a procedure that is almost custom-made for outpatient surgery,” Petrigliano said. “There is little blood loss and you can employ effective regional anesthesia to provide postoperative pain relief. So, I think in the future, we need to identify if there are certain patients [who] should not have TSAs in the outpatient setting. If we can identify those patients, then I think we are going to see TSA done routinely in the outpatient setting.” – by Casey Tingle
- Reference:
- Arshi A, et al. Orthopedics. 2018;doi:10.3928/01477447-20180409-01.
- For more information:
- Frank A. Petrigliano, MD, can be reached at 1250 16th St., Santa Monica, CA 90404; email: fpetrigliano@mednet.ucla.edu.
Disclosure: Petrigliano reports no relevant financial disclosures.