Dr. Greg Nicholson, Midwest Orthopedics at Rush, Chicago IL, discusses a recent publication “Outpatient Shoulder Arthroplasty: Outcomes, Complications, and Readmissions in 2 Outpatient Settings”.
Wright Medical Clinical Summary
To view online: https://pubmed.ncbi.nlm.nih.gov/31133407/
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-S123. doi: 10.1016/j.jse.2019.04.006. Epub 2019 May 24. Data on file.
Brolin T, Throckmorton T. Outpatient Shoulder Arthroplasty. Orthopedic Clinics of North America 2018 Jan;49(1):73-79. SKU: AP-013809A
recently it rush. We've published a study on outpatient shoulder Arthur Plast E Um, we had 50 patients, the vast majority, 44 of them being total shoulders in an outpatient setting. What we wanted to do is try to look is an outpatient setting for total shoulder. Arthur Plastic is safe and effective, compared Toa impatient on what we did there. We looked at the demographics and really, like any procedure we do in orthopedics. Patient selection is so important, I think, one of the things we're looking at, we're trying to do something that's effective and lower cost. But at the same time, we have a problem because Medicare does not recognize a code. If you if you code for a total shoulder and doing it is an outpatient, it's almost like it didn't happen because Medicare doesn't recognize that now. Total hip in total knee lower extremities Arthur Plasticky have been done in outpatient setting sooner than total shoulder. Obviously, there's more volume there, but at the same time there's a higher complication rate and lower extremities Arthur Plast C than upper extremity Arthur plastic specifically shoulder. Thus, when we looked at it from 2000 and 14 to 2000 and 17. The big the big problems with outpatient Arthur Plastic, as you might imagine, would be number one pain control, number two, blood loss and then number three complications Number four would actually be cost and then patient satisfaction. What we found in this study waas our complication rate was comparable to inpatient are really are readmission. Rate was 2%. That's one person out of 50. The patient satisfaction was extremely high. And then if you look at patient demographics, they were about age 56. Their body mass index was 29. Ah, majority of males versus females. And when you look at complication rates or dissatisfaction rates in shoulder Arthur plastic, one of them is, um, co Morbidity index. How maney morbidity is do they have female gender steroid use and then body mass index and somewhat, uh, accounting for those? We didn't see that to be a huge effect on what we're doing. Thus we were able to have excellent results comparable to inpatient Arthur plasticky both by complication rate, um, pain relief, patient satisfaction, readmission. Thus, we think that outpatient shoulder Arthur plastic is a wonderful way to proceed. The two big stumbling blocks would be the pain issue. And with indwelling, catheters and pain management, I think we've handled that number two. What about blood loss? Obviously we're doing on Arthur Plasticky. Well, the transfusion rate in a an atomic total shoulder is 1% or less in a in a reverse. It's 2% or less. So those things, I think we've handled very, very well. The real risk is OK, what about an infection? They're not gonna be in the hospital for 24 hours. What we do is we give them a preoperative ivy antibiotic, and before they leave, they get another ivy antibiotic. And the average time that that patient was in the institution was about 9.5 hours. So that gives you the ability. Now we had one infection, but that did not come up for four months Now. What we looked at was the 90 day complication rate that would have been outside that 90 day complication rates. So when you look at some of the literature, you're talking about 30 day complication rate and 90 day complication rate. So we think that in selected patients outpatient shoulder Arthur plast e is the the equal to inpatient. Now, one of the qualms would be Wait a minute. I have Ah, I have a patient who maybe is a little heavier. They're b m I 35 I can't do it in a free standing outpatient surgery center where they have Mawr. Co morbidity is what we're saying in a in a hospital outpatient environment, where it might be easier if they're having problems toe, admit them. That's where the surgeons should start out and even And we compared our freestanding A S C patients toe Ah, hospital outpatient environment. There was absolutely no difference. So that's a good way to start. But again, that comes down to patient selection. So, um, I think it's here to stay. We have to be very careful on what we do. Uh, there was an excellent study that showed you could save $4000 per case in some of the costs by doing it by outpatient. But obviously the system is the solution. You have to have everybody on board anesthesia. The patient, the family. I think we have to delve into the social environment of that patient. Do they have family help at home, and And here comes the next one, if you if you remember what I said earlier, we did 50 patients, and 44 of them were total shoulders. We're 60% to 65% of all shoulder Arthur plastic in the world and in the United States now is reverse total shoulder. They have Mork Co morbidity. Is there a little bit older? They might have a social issue at home. We have to be very, very careful about that in an outpatient setting. So I think patient selection is the key way. Have anesthesia has to be on board. Their medical doctor has to be on board. The family has to be on board the patient, the surgeon. But all that being said, I think outpatient shoulder Arthur plastic is a, uh, incredibly viable, uh, cost saving issue without compromising what we really want, which is an excellent result for that patient. Mhm