What is Outpatient Shoulder Arthroplasty?
Outpatient total shoulder arthroplasty (TSA) refers to shoulder arthroplasty where the patient goes home on the same day as the surgery. During TSA, a surgeon replaces a diseased or damaged shoulder joint with a prosthesis (artificial joint). Shoulder arthroplasty provides a long-term solution to restore shoulder function and alleviate pain from a variety of shoulder conditions, including osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, rotator cuff tear arthropathy, fractures, osteonecrosis, and more.
There has been a recent increase in outpatient TSA as a result of restrictions placed on inpatient surgeries due to COVID-19. Dr. Hettrich, however, has been utilizing outpatient TSA for over ten years. Over the past decade, Dr. Hettrich has developed and refined a safe, convenient, and effective outpatient shoulder replacement program, safely sending home nearly one thousand highly satisfied patients.
I Thought Joint Replacement Surgeries Require Staying in the Hospital?
While at one point all joint replacement surgeries necessitated a stay in the hospital, advancements in surgical techniques, medical devices, and pain management have made outpatient joint replacements not only possible, but preferable in certain patients. Shoulder replacements have a much lower rate of medical complications than hip and knee replacements, making them great for outpatient surgery.
What Are the Advantages of Outpatient TSA?
Most patients prefer recovering in the comfort and familiarity of their own home. A hospital setting can be filled with distractions, making it difficult to obtain adequate rest. Additionally, hospital stays come with known risks.
Several studies have shown that patients who undergo outpatient TSA have better outcomes and fewer complications than patients who undergo inpatient TSA. One study, which examined over 100,000 patients, showed that outpatient TSA is associated with lower rates of several complications, including thromboembolic events and surgical-site infections (1). Dr. Hettrich has also published research on this topic. Her work, based on data from nearly 500 hospitals, demonstrated that patients who stayed at the hospital for one day or less after TSA had a lower incidence of pneumonia, urinary tract infections, blood transfusions, and total complications. She and her team found an overall complication rate of 1.8% for short-stay TSA patients, compared to 5.0% for longer-stay patients (2). A recent systematic review by Cimino included data on over 190,000 patients and found a lower complication rate in outpatients, and no significant difference in rates of 90-day readmission, revision, or infection (3).
What About Pain Management?
There have been many advancements in anesthesia and pain management in recent years that enable optimum pain management for patients undergoing shoulder replacement, while minimizing the use of narcotics. The majority of patients will receive regional nerve blocks, and some patients are candidates for take-home pain pumps such as the ON-Q. Many patients who have the pain pump report that they had no pain at all! Pain medication is multimodal, meaning it addresses different pain pathways to minimize pain.
Is Outpatient TSA for Everyone?
Patients with certain medical conditions may require a hospital stay after TSA. Additionally, patients who do not have anyone to stay with them after surgery are not good candidates for the outpatient procedure.
Dr. Hettrich and the anesthesia team assess each patient and case individually to carefully determine the best setting for any procedure. There is also flexibility on the day of surgery to change from being an outpatient surgery to staying overnight if the medical team determines it is in the best interest of the patient to remain in the hospital, or if they patients do not feel comfortable returning home.
References
(1) Basques BA, Erickson BJ, Leroux T, Griffin JW, Frank RM, Verma NN, Romeo AA. Comparative outcomes of outpatient and inpatient total shoulder arthroplasty: an analysis of the Medicare dataset. Bone Joint J. 2017 Jul;99-B(7):934-938.
(2) Duchman KR, Anthony CA, Westermann RW, Pugely AJ, Gao Y, Hettrich CM. Total Shoulder Arthroplasty: Is Less Time in the Hospital Better? Iowa Orthop J. 2017;37:109-116.
(3) Cimino AM, Jawkins JK, McGwin G, Brabson EW, Ponce BA, Momaya AM. Is outpatient shoulder arthroplasty safe? A systematic review and meta-analysis. Journal Shoulder and Elbow Surgery. 2021