Reverse total shoulder arthroplasty (RTSA) is an effective treatment option for many shoulder conditions. Historically this surgery was performed on an inpatient basis. There has been a recent trend to perform RTSA on an outpatient basis in proper candidates. The purpose of this study was to report the demographics, clinical outcomes, and complications for patients undergoing RTSA as an outpatient. A secondary purpose was to compare the demographics, clinical outcomes, and complications for patients undergoing RTSA as an outpatient vs. inpatient. The authors’ hypothesized that there would be a significant improvement in clinical outcome scores and a low complication rate following RTSA as an outpatient with no difference in clinical outcomes or complications between inpatient vs. outpatient RTSA. The authors also hypothesized that patients undergoing RTSA on an inpatient basis would have higher American Society of Anesthesiologists (ASA) Classification than those undergoing RTSA on an outpatient basis.
All patients who underwent outpatient RTSA by a single surgeons between 2015-2017 were included. Demographic information and clinical outcomes scores (American Shoulder an Elbow Surgeons (ASES), Visual Analog Scale (VAS), Single Assessment Numerical Evaluation (SANE)), as well as data on complications, re-admission, and revision surgeries were recorded. This group of patients was then compared to a cohort of patients who underwent RTSA in the inpatient setting over the same time period.
Overall, 241 patients (average age 68.9, 52.3% female), underwent outpatient RTSA and were included. Patients who underwent outpatient RTSA saw significant improvement in all clinical outcome scores at both 1 and 2 year postoperatively (all p<0.0001). The control group of patients who underwent RTSA as an inpatient consisted of 373 patients (average age 72, 66% female). Significantly more controls had diabetes (p=0.007) and controls had a higher body mas index (p=0.022). No significant differences existed in improvements in clinical outcome scores between inpatients vs. outpatient groups. Complication rates were significantly lower for outpatient cases than for inpatient controls (7.0% vs. 12.7% p=0.023).
RTSA performed in an outpatient setting is a safe and reliable procedure that provides significant improvements in clinical outcome scores with fewer complications compared to inpatient RTSA.