Section of Orthopedics, Department of Surgery, Orthopaedic Surgery Resident, Hamad General Hospital, PO Box 3050, Doha, Qatar.
Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, NY, USA.
Int Orthop. 2021 Mar;45(3):697-710. doi: 10.1007/s00264-021-04940-7. Epub 2021 Jan 23.
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.
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.
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.
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.
为了满足日益增长的全肩关节置换术（TSA）需求，同时减轻其经济负担，手术模式已逐渐向门诊手术转变。本系统评价和荟萃分析旨在评估门诊 TSA 的安全性。
主要目的是比较门诊和住院 TSA 的再入院率和术后并发症。次要目标是功能结果和成本。检索了 PubMed、Google Scholar 和 Web of Science，检索时间截至 2020 年 3 月 28 日。纳入标准为至少报告了 30 天或更长时间内并发症或再入院率的研究。
纳入了 10 项 III 级回顾性研究，分别有 7637（3.8%）和 192025（96.2%）例患者接受了门诊和住院 TSA。门诊 TSA 患者相对更年轻、更健康。门诊和住院 TSA 在 30 天和 90 天再入院方面没有差异。此外，未调整的比较显示，门诊 TSA 在总并发症和主要手术并发症、总并发症、主要并发症和次要医疗并发症方面明显较少。但是，如果研究具有匹配对照且无论数据来源（数据库研究或非数据库研究）如何，亚组分析均表明，所有并发症都没有显著差异。在 12-24 个月的随访中，两组的翻修率相似。有两项研究报告称，门诊 TSA 可显著降低成本。
本研究表明，在适当选择的患者中，门诊 TSA 可能是住院 TSA 的一种安全有效的替代方案。门诊 TSA 不会导致再入院、并发症或翻修率增加。门诊 TSA 的潜在额外益处是降低成本。
