Orthopedics. 2021 Mar-Apr;44(2):e215-e222. doi: 10.3928/01477447-20201216-01. Epub 2020 Dec 30.
Whether shoulder arthroplasty can be performed on an outpatient basis depends on appropriate patient selection. The purpose of this study was to identify risk factors for adverse events (AEs) following shoulder arthroplasty and to generate predictive models to improve patient selection. This was a retrospective review of prospectively collected data using a single institution shoulder arthroplasty registry as well as the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, including subjects undergoing hemiarthroplasty, total shoulder arthroplasty (TSA), and reverse TSA. Predicted probability of suitability for same-day discharge was calculated from multivariable logistic models for different patient subgroups based on age, comorbidities, and Charlson/Deyo Index scores. A total of 2314 shoulders (2079 subjects) in the institutional registry met inclusion criteria for this study. Younger age, higher body mass index (BMI), male sex, and prior steroid injection were all significantly associated with suitability for discharge, whereas preoperative narcotic use, comorbidities (heart disease and anemia/other blood disease), and Charlson/Deyo Index score of 2 were associated with AEs that might prevent same-day discharge. Compared with TSA, reverse TSA was associated with less suitability for discharge (=.01). On querying the ACS-NSQIP database, 15,254 patients were identified. Female sex, BMI less than 35 kg/m, American Society of Anesthesiologists class III/IV, preoperative anemia, functional dependence, low pre-operative albumin, and hemiarthroplasty were associated with unsuitability for discharge. Males 55 to 59 years old with no comorbidities nor history of narcotic use formed the lowest risk subgroup. Transfusion is the primary driver of AEs. Strategies to avoid this complication should be explored. Risk stratification will improve the ability to identify patients who can safely undergo outpatient shoulder arthroplasty. [. 2021;44(2):e215-e222.].
肩关节置换术能否在门诊进行取决于合适的患者选择。本研究的目的是确定肩关节置换术后不良事件（AE）的危险因素，并建立预测模型以改善患者选择。这是对一家机构的肩关节置换登记处以及美国外科医师学会国家手术质量改进计划（ACS-NSQIP）数据库进行前瞻性数据收集的回顾性研究，包括行半肩关节置换术、全肩关节置换术（TSA）和反式 TSA 的患者。根据年龄、合并症和 Charlson/Deyo 指数评分，基于多变量逻辑模型为不同患者亚组计算出适合当日出院的预测概率。机构登记处符合本研究纳入标准的共 2314 个肩关节（2079 例）。年龄较小、体质量指数（BMI）较高、男性和术前类固醇注射均与适合出院显著相关，而术前使用麻醉药物、合并症（心脏病和贫血/其他血液疾病）和 Charlson/Deyo 指数评分为 2 与可能妨碍当日出院的 AE 相关。与 TSA 相比，反式 TSA 与较低的出院适合度相关（P<.01）。在查询 ACS-NSQIP 数据库时，确定了 15254 例患者。女性、BMI 小于 35kg/m、ASA 分级 III/IV、术前贫血、功能依赖、低术前白蛋白和行半肩关节置换术与不适合出院相关。无合并症且无麻醉药物使用史的 55 至 59 岁男性构成风险最低的亚组。输血是 AE 的主要驱动因素。应探讨避免这种并发症的策略。风险分层将提高识别能够安全进行门诊肩关节置换术的患者的能力。[2021;44(2):e215-e222.]。
