Same-day discharge shoulder arthroplasty: Perioperative protocol and initial results
DOI:
https://doi.org/10.1016/j.rccot.2021.06.002Keywords:
Shoulder arthroplasty, Outpatient, Elastomeric pump, Evidence level: IVAbstract
Background: Shoulder arthoplasty is an effective procedure to improve pain and function in chronic shoulder pathologies. Considering the risks and costs associated with hospital stay, performing joint replacements on an outpatient setting emerges as an option to optimize this therapeutic strategy.
Methods: A prospective analysis was performed in 10 patients undergoing same-day discharge total shoulder arthroplasty with anatomic and reverse prostheses. Pain was managed with a continuous peripheral interscalene block using an elastomeric infusion pump. ASES and SANE scores, pain, patient satisfaction, complications, and readmissions after 90 days were recorded.
Results: 10 patients (average age 59.6 (±3.9) years) underwent outpatient shoulder arthroplasty (50% reverse shoulder arthroplasty, 40% total shoulder arthroplasty and 10% hemiarthroplasty). On post-operative day 4, mean visual analogue scale (VAS) for pain assessment was 1.3 (±0.62) and day 10, 2.7 (±1.1). Pre-operative SANE score was 31 (±9.7), and 90 days after the procedure was 76.1 (±6.8). All patients were satisfied with the procedure. One patient had a mild bronchospasm on day 3 that resolved with bronchodilators on an outpatient basis. One patient had a superficial surgical site infection that resolved completely with oral antibiotics administration. There were no re-admissions or major complications.
Discussion: We present short- to medium-term outcomes of the first case series in our setting of shoulder replacement performed with same-day discharge. This procedure can be performed safely, following a standardized protocol and making a judicious selection of patients.
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Rasmussen JV, Amundsen A, Sørensen AKB, Klausen TW, Jakobsen J, Jensen SL, et al. Increased use of total shoulder arthroplasty for osteoarthritis and improved patient-reported outcome in Denmark, 2006-2015: a nationwide cohort study from the Danish Shoulder Arthroplasty Registry. Acta Orthop. 2019;90:489-94, http://dx.doi.org/10.1080/17453674.2019.1633759.
Harjula JNE, Paloneva J, Haapakoski J, Kukkonen J, Äärimaa V, Honkanen P, et al. Increasing incidence of primary shoulder arthroplasty in Finland - A nationwide registry study. BMC Musculoskelet Disord. 2018;19:245, http://dx.doi.org/10.1186/s12891-018-2150-3.
Kim SH, Wise BL, Zhang Y, Szabo RM. Increasing incidence of shoulder arthroplasty in the United States. J Bone Jt Surg - Ser A. 2011;93:2249-54, http://dx.doi.org/10.2106/JBJS.J. 01994.
Fehringer EV, Mikuls TR, Michaud KD, Henderson WG, O’Dell JR. Shoulder arthroplasties have fewer complications than hip or knee arthroplasties in US veterans. Clin Orthop Relat Res. 2010;468:717-22, http://dx.doi.org/10.1007/s11999-009-0996-2.
Farmer KW, Hammond JW, Queale WS, Keyurapan E, McFarland EG. Shoulder arthroplasty versus hip and knee arthroplasties: A comparison of outcomes. Clin Orthop Relat Res. 2007;455:183-9, http://dx.doi.org/10.1097/01.blo.0000238839.26423.8d.
Shah A, Nielsen KC, Braga L, Pietrobon R, Klein SM, Steele SM. Inter scalene brachial plexus block for outpatient shoulder arthroplasty: Postoperative analgesia, patient satisfaction and complications. Indian J Orthop. 2007;41:230-6, http://dx.doi.org/10.4103/0019-5413.33688.
Ilfeld BM, Wright TW, Enneking FK, Mace JA, Shuster JJ, Spadoni EH, et al. Total shoulder arthroplasty as an outpatient procedure using ambulatory prerineural local anesthetic infusion: A pilot feasibility study. Anesth Analg. 2005;101:1319-22, http://dx.doi.org/10.1213/01.ANE. 0000180199.52383.CE.
Fournier MN, Brolin TJ, Azar FM, Stephens R, Throckmorton TW. Identifying appropriate candidates for ambulatory outpatient shoulder arthroplasty: validation of a patient selection algorithm. J Shoulder Elb Surg. 2019;28:65-70, http://dx.doi.org/10.1016/j.jse.2018.06.017.
March L, Smith EUR, Hoy DG, Cross MJ, Sanchez- Riera L, Blyth F, et al. Burden of disability due to musculoskeletal (MSK) disorders. Best Practice and Research: Clinical Rheumatology. 2014;28:353-66, http://dx.doi.org/10.1016/j.berh.2014.08.002.
Issa K, Pierce CM, Pierce TP, Boylan MR, Zikria BA, Naziri Q, et al. Total Shoulder Arthroplasty Demographics Incidence, and Complications-A Nationwide Inpatient Sample Database Study. Surg Technol Int. 2016;29:240-6.
Petrillo S, Longo UG, Papalia R, Denaro V. Reverse shoulder arthroplasty for massive irreparable rotator cuff tears and cuff tear arthropathy: a systematic review. Musculoskeletal Surgery. 2017;101:105-12, http://dx.doi.org/10.1007/s12306-017-0474-z.
Samitier G, Alentorn-Geli E, Torrens C, Wright TW. Reverse shoulder arthroplasty Part 1: Systematic review of clinical and functional outcomes. Int J Shoulder Surg. 2015;9:24-31, http://dx.doi.org/10.4103/0973-6042.150226.
Smith GCS, Bateman E, Cass B, Damiani M, Harper W, Jones H, et al. Reverse Shoulder Arthroplasty for the treatment of Proximal humeral fractures in the Elderly (ReShAPE trial): Study protocol for a multicentre combined randomised controlled and observational trial. Trials. 2017;18:91, http://dx.doi.org/10.1186/s13063-017-1826-6.
Menendez ME, Lawler SM, Ring D, Jawa A. High pain intensity after total shoulder arthroplasty. J Shoulder Elb Surg. 2018;27:2113-9, http://dx.doi.org/10.1016/j.jse.2018.08.001.
Berger RA, Kusuma SK, Sanders SA, Thill ES, Sporer SM. The feasibility and perioperative complications of outpatient knee arthroplasty. In: Clinical Orthopaedics and Related Research. 2009;467:1443-9, http://dx.doi.org/10.1007/s11999-009-0736-7.
Pollock M, Somerville L, Firth A, Lanting B. Outpatient total hip arthroplasty, total knee arthroplasty, and unicompartmental knee arthroplasty: A systematic review of the literature. JBJS Reviews. 2016;4, http://dx.doi.org/10.2106/JBJS.RVW.16.00002.01874474-201612000-00004.
Hoffmann JD, Kusnezov NA, Dunn JC, Zarkadis NJ, Goodman GP, Berger RA. The Shift to Same-Day Outpatient Joint Arthroplasty: A Systematic Review. Journal of Arthroplasty. 2018;4, http://dx.doi.org/10.2106/JBJS.RVW.16.00002,01874474-201612000-00004.
Brolin TJ, Mulligan RP, Azar FM, Throckmorton TW. Neer Award 2016: Outpatient total shoulder arthroplasty in an ambulatory surgery center is a safe alternative to inpatient total shoulder arthroplasty in a hospital: a matched cohort study. J Shoulder Elb Surg. 2017;26:204-8, http://dx.doi.org/10.1016/j.jse.2016.07.011.
Brolin TJ, Cox RM, Zmistowski BM, Namdari S, Williams GR, Abboud JA. Surgeons’ experience and perceived barriers with outpatient shoulder arthroplasty. J Shoulder Elb Surg. 2018;27(6S):S82-7, http://dx.doi.org/10.1016/j.jse.2018.01.018.
Bean BA, Connor PM, Schiffern SC, Hamid N. Outpatient Shoulder Arthroplasty at an Ambulatory Surgery Center Using a Multimodal Pain Management Approach. JAAOS Glob Res Rev. 2018;2:e064, http://dx.doi.org/10.5435/JAAOSGlobal-D-18-00064.
Leroux TS, Zuke WA, Saltzman BM, Go B, Verma NN, Romeo AA, Hurst J, Forsythe B. Safety and patient satisfaction of outpatient shoulder arthroplasty. JSES Open Access. 2018;2:13-7, http://dx.doi.org/10.1016/j.jses.2017.11.002.
Ahmed AF, Hantouly A, Toubasi A, Alzobi O, Mahmoud S, Qaimkhani S, Ahmed GO, Al Dosari MAA. The safety of outpatient total shoulder arthroplasty: a systematic review and meta-analysis. Int Orthop. 2021 Mar;45:697-710, http://dx.doi.org/10.1007/s00264-021-04940-7.
Nwankwo CD, Dutton P, Merriman JA, Gajudo G, Gill K, Hatch J. Outpatient Total Shoulder Arthroplasty Does Not Increase the 90-Day Risk of Complications Compared With Inpatient Surgery in Prescreened Patients. Orthopedics. 2018 Jul 1;41:e563-8, http://dx.doi.org/10.3928/01477447-20180524-04.
Charles MD, Cvetanovich G, Sumner-Parilla S, Nicholson GP, Verma N, Romeo AA. Outpatient shoulder arthroplasty: outcomes, complications, and readmissions in 2 outpatient settings. J Shoulder Elbow Surg. 2019 Jun;28(6S):S118-23, http://dx.doi.org/10.1016/j.jse.2019.04.006.
Antonacci CL, Cu BJ, Erickson BJ, Vazquez O, Alberta FG. Complications and Readmissions After Reverse and Anatomic Total Shoulder Arthroplasty With Same-day Discharge. J Am Acad Orthop Surg. 2021 Feb 1;29:116-22, http://dx.doi.org/10.5435/JAAOS-D-20-00245.
Nelson CG, Murphy WG, Mulligan RP, Brolin TJ, Azar FM, Throckmorton TW. A retrospective comparative study of patient satisfaction following ambulatory outpatient and inpatient total shoulder arthroplasty. Current Orthopaedic Practice. 2019;30:1, http://dx.doi.org/10.1097/BCO.0000000000000787.
Villalba J, Peñalver J, Torner P, Serra M, Planell J. Home-based intravenous analgesia with elastomeric pump as an outpatient procedure for pain control after anterior cruciate ligament repair. Rev Esp Cir Ortop Traumatol (Engl Ed). 2018 Jan-Feb;62:65-70, http://dx.doi.org/10.1016/j.recot.2017.07.005. English, Spanish.
Fredrickson MJ, Abeysekera A, Price DJ, Wong AC. Patientinitiated mandatory boluses for ambulatory continuous interscalene analgesia: an effective strategy for optimizing analgesia and minimizing side-effects. Br J Anaesth. 2011 Feb;106:239-45, http://dx.doi.org/10.1093/bja/aeq320.
Theodorides AA. The role of elastomeric pumps in postoperative analgesia in orthopaedics and factors affecting their flow rate. J Perioper Pract. 2017 Dec;27:276-82, http://dx.doi.org/10.1177/175045891702701205.
Ramírez-Latorre JL, Patiño-Arias A, López-Hernández CA, Giraldo-Salazar O, Yepes-Tejada DA, Erazo-Posada SE. Ambulatory intravenous analgesia using elastomeric pumps in patients undergoing plastic surgery: Prospective case series. Colombian Journal of Anesthesiology. 2018;46(Supp):3-7, http://dx.doi.org/10.1097/cj9.0000000000000038.
Courtney PM, Boniello AJ, Berger RA. Complications Following Outpatient Total Joint Arthroplasty: An Analysis of a National Database. J Arthroplasty. 2017;32:1426-30, http://dx.doi.org/10.1016/j.arth.2016.11.055.
Harrison AK, Throckmorton TW, Shumate DH, Braman JP. Outpatient and Semi-Outpatient Total Shoulder Replacement: Patient Selection and Program Management. Instr Course Lect. 2020;69:575-82.
Cancienne JM, Brockmeier SF, Gulotta LV, Dines DM, Werner BC. Ambulatory total shoulder arthroplasty: A comprehensive analysis of current trends, complications, readmissions, and costs. Journal of Bone and Joint Surgery - American Volume. 2017;99:629-37, http://dx.doi.org/10.2106/JBJS.16.00287.
Crawford DC, Li CS, Sprague S, Bhandari M. Clinical and cost implications of inpatient versus outpatient orthopedic surgeries: A systematic review of the published literature. Orthopedic Reviews. 2015;7:6177, http://dx.doi.org/10.4081/or.2015.6177.
Ode GE, Odum S, Connor PM, Hamid N. Ambulatory versus inpatient shoulder arthroplasty: a population-based analysis of trends, outcomes, and charges. JSES Int. 2020;4:127-32, http://dx.doi.org/10.1016/j.jses.2019.10.001.
Matar RN, Gardner TJ, Kassam F, Grawe BM. When do patients truly reach maximal medical improvement after undergoing reverse shoulder arthroplasty? The incidence and clinical significance of pain and patient-reported outcome measure improvement. JSES Int. 2020.
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