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Meta-Analysis
. 2021 Mar;45(3):697-710.
doi: 10.1007/s00264-021-04940-7. Epub 2021 Jan 23.

The safety of outpatient total shoulder arthroplasty: a systematic review and meta-analysis

Abdulaziz F Ahmed  1 , Ashraf Hantouly  2 , Ammar Toubasi  2 , Osama Alzobi  2 , Shady Mahmoud  3 , Saeed Qaimkhani  2 , Ghalib O Ahmed  2 , Mohammed Al Ateeq Al Dosari  2
Affiliations
Meta-Analysis

The safety of outpatient total shoulder arthroplasty: a systematic review and meta-analysis

Abdulaziz F Ahmed et al. Int Orthop. 2021 Mar.

Abstract

Purpose: To meet the increasing demands of total shoulder arthroplasty (TSA) while reducing its financial burden, there has been a shift toward outpatient surgery. This systematic review and meta-analysis aimed to evaluate the safety of outpatient TSA.

Methods: The primary objective was to compare re-admission rates and postoperative complications in outpatient versus inpatient TSA. The secondary objectives were functional outcomes and costs. PubMed, Google Scholar, and Web of Science were searched until March 28, 2020. The inclusion criteria were studies reporting at least complications or readmission rates within a period of 30 days or more.

Results: Ten level III retrospective studies were included with 7637 (3.8%) and 192,025 (96.2%) patients underwent outpatient and inpatient TSA, respectively. Outpatient TSA had relatively younger and healthier patients. There were no differences between outpatient and inpatient arthroplasty for 30- and 90-day readmissions. Furthermore, unadjusted comparisons demonstrated significantly less total and major surgical complications, less total, major, and minor medical complications in favour of outpatient TSA. However, subgroup analyses demonstrated that there were no significant differences in all complication if the studies had matched controls and regardless of data source (database or nondatabase studies). The revision rates were similar between both groups at a 12-24 months follow-up. Two studies reported a significant reduction in costs in favour of outpatient TSA.

Conclusion: This study highlights that outpatient TSA could be a safe and effective alternative to inpatient TSA in appropriately selected patients. It was evident that outpatient TSA does not lead to increased readmissions, complications, or revision rates. A potential additional benefit of outpatient TSA was cost reduction.

Keywords: Ambulatory; Arthroplasty; Meta-analysis; Outpatient; Systematic review; Total shoulder.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
The search strategy flowchart
Fig. 2
Fig. 2
Comparison of 30-day readmissions between outpatient and inpatient total shoulder arthroplasty (TSA). CI: confidence interval
Fig. 3
Fig. 3
Comparison of overall 90-day readmissions between outpatient and inpatient total shoulder arthroplasty (TSA) with subgroup analyses for data source and controls. CI: confidence interval
Fig. 4
Fig. 4
Comparison of overall total surgical complications between outpatient and inpatient total shoulder arthroplasty (TSA) with subgroup analyses for data source and controls. CI: confidence interval
Fig. 5
Fig. 5
Comparison of overall major surgical complications between outpatient and inpatient total shoulder arthroplasty (TSA) with subgroup analyses for data source and controls. CI: confidence interval
Fig. 6
Fig. 6
Comparison of overall minor surgical complications between outpatient and inpatient total shoulder arthroplasty (TSA) with subgroup analyses for data source and controls. CI: confidence interval
Fig. 7
Fig. 7
Comparison of overall total medical complications between outpatient and inpatient total shoulder arthroplasty (TSA) with sub-group analyses for data source and controls. CI: confidence interval
Fig. 8
Fig. 8
Comparison of overall major medical complications between outpatient and inpatient total shoulder arthroplasty (TSA) with subgroup analyses for data source and controls. CI: confidence interval
Fig. 9
Fig. 9
Comparison of overall minor medical complications between outpatient and inpatient total shoulder arthroplasty (TSA) with subgroup analyses for data source and controls. CI: confidence interval
Fig. 10
Fig. 10
Comparison of revision rates between outpatient and inpatient total shoulder arthroplasty (TSA) with subgroup analyses for data source and controls. CI: confidence interval
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