Speaker: Consider surgical, patient factors prior to implementation of outpatient TSA
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WAIKOLOA, Hawaii — In a Facebook Live event hosted at Orthopedics Today Hawaii, Xavier A. Duralde, MD, noted more surgeons have begun to perform outpatient total shoulder arthroplasty, which has been accelerated by the COVID-19 pandemic.
“I think we’re going to get to the point where 90% [of shoulder arthroplasties] are done as an outpatient,” Duralde said. “You’re still going to have fracture cases, you have the sick patients who need an overnight stay, but there’s no reason why the vast majority can’t go as an outpatient.”
Prior to implementing outpatient TSA into your practice, Duralde noted surgeons need to be sure they are confident that the operation can be performed within 2 hours.
“It’s been shown that surgeons that take longer than that have a higher readmission rate,” Duralde said.
He added surgeons need to make sure their office can support the patient during the week after surgery. This includes providing patient education, understanding the responsibilities of the patient and staff, and coaching patients on what to expect at every step, according to Duralde.
Duralde noted surgeons should only perform ambulatory or outpatient TSA among younger and healthier patients. He added patient selection also depends on whether the internist believes the procedure is safe for that particular patient.
“In general, we’re looking at patients under the age of 70, not anemic, good heart, good lungs and patients who don’t have a history of deep vein thrombosis,” Duralde said. “Those are your ideal population to offer total shoulder arthroplasty as an outpatient.”
Patients undergoing outpatient TSA should receive an interscalene block with a long-acting agent, as well as oral medications for postoperative pain, according to Duralde. He added surgeons may also be able to provide patients undergoing outpatient TSA with one dose of antibiotics and forgo the use of a drain.
“We want to do skin prep the night before to make sure we decolonize the skin as much as possible. But some of those things, like drains, we find ... you don’t need to put a drain into most cases and then, antibiotics, one dose seems to do the trick,” Duralde said.
In addition to performing an anatomic TSA as an outpatient procedure, Duralde said it is possible to perform reverse shoulder arthroplasty as an outpatient procedure and have the patient return the next day for evaluation.
“One piece of advice for surgeons who are starting to do this is it’s not a bad idea to have the patient to come back the next morning just to check them out, reassure them and make sure everything is going OK,” Duralde said.
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VIDEO: ‘Table has been set’ for outpatient total shoulder arthroplasty. https://www.healio.com/news/orthopedics/20220111/video-table-has-been-set-for-outpatient-total-shoulder-arthroplasty. Published Jan. 11, 2022. Accessed Jan. 11, 2022.
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