University of Texas Health Science Center at Houston, Houston, TX, USA.
University of Texas Health Science Center at Houston, Houston, TX, USA.
J Shoulder Elbow Surg. 2021 Oct;30(10):2306-2311. doi: 10.1016/j.jse.2021.02.022. Epub 2021 Mar 19.
Recent studies indicate that outpatient total shoulder arthroplasty (TSA) is cost-effective and may have a low complication rate similar to inpatient TSA. However, existing studies have included younger patient cohorts who typically possess fewer medical comorbidities. Patients aged ≥65 years are commonly enrolled in Medicare, which has traditionally designated TSA as an inpatient-only procedure. The purpose of this study was to compare surgical complication rates and 90-day readmission rates between inpatient and outpatient TSA performed in adults aged ≥65 years.
Medical records for all patients aged ≥65 years who underwent primary anatomic or reverse TSA by a single surgeon from July 2015 to May 2020 were reviewed. Patients were preselected for outpatient or inpatient surgery based on lack of significant cardiopulmonary comorbidities and patient preference. Demographics, body mass index (BMI), and American Society of Anesthesiologists (ASA) scores were collected in addition to emergency department (ED) visits and readmissions within 90 days of the index surgery. Relationships among frequency and types of complications and surgical setting (inpatients vs. outpatient) were assessed. Complication rates and demographic variables between inpatient and outpatient procedures were compared. Logistic regressions were performed to account for interacting predictor variables on the odds of having complications.
A total of 145 shoulders (138 patients; 95 male, 43 female) were included in the analysis, of which 98 received inpatient TSA and 47 received outpatient TSA. Average age was 75.5 ± 7.2 for inpatient TSA and 70.5 ± 4.5 for outpatient TSA (P < .001). Patient age (P < .001), ASA score ≥3 (P < .001), and reverse TSA (P = .002) were significantly positively correlated with receiving inpatient surgery. There were 16 complications (16.3%) in the inpatient group and 9 complications (19.1%) in the outpatient group (P = .648). There were no significant differences in the frequency of postoperative complications, return to the ED, or reoperations between inpatient and outpatient procedures (P > .05). Each 1-year increase in age increased the predicted odds of having a surgical complication by 14% (odds ratio = 1.14; P = .021), irrespective of surgical setting. Those who underwent inpatient TSA had a significantly higher frequency of 90-day readmission (inpatient=16, outpatient=1; P = .034).
Postoperative complications and ED returns were not significantly different between inpatient and outpatient TSA. Each 1-year increase in age increased the odds of postoperative surgical complications by 14%, regardless of surgical setting. Outpatient TSA was found to be safe for appropriately selected patients aged ≥65 years, and re-evaluation of TSA as an inpatient-only procedure should be considered.
最近的研究表明，门诊全肩关节置换术（TSA）具有成本效益，并且可能具有与住院 TSA 相似的低并发症发生率。然而，现有研究包括了年龄较小的患者，他们通常患有较少的合并症。年龄≥65 岁的患者通常参加医疗保险，医疗保险通常将 TSA 指定为仅住院手术。本研究的目的是比较≥65 岁成年人进行的门诊和住院 TSA 的手术并发症发生率和 90 天再入院率。
回顾了 2015 年 7 月至 2020 年 5 月期间由一名外科医生为≥65 岁的患者进行的原发性解剖或反向 TSA 的所有患者的病历。根据是否存在显著的心肺合并症和患者偏好，患者被预先选择接受门诊或住院手术。除了急诊就诊和索引手术后 90 天内的再入院外，还收集了人口统计学、体重指数（BMI）和美国麻醉医师协会（ASA）评分。评估了并发症的频率和类型与手术环境（住院 vs. 门诊）之间的关系。比较了住院和门诊手术的并发症发生率和人口统计学变量。进行逻辑回归以解释预测变量对并发症发生概率的相互作用。
共有 145 个肩膀（138 名患者；95 名男性，43 名女性）被纳入分析，其中 98 例接受了住院 TSA，47 例接受了门诊 TSA。住院 TSA 的平均年龄为 75.5±7.2 岁，门诊 TSA 的平均年龄为 70.5±4.5 岁（P<0.001）。患者年龄（P<0.001）、ASA 评分≥3（P<0.001）和反向 TSA（P=0.002）与接受住院手术显著正相关。住院组有 16 例（16.3%）并发症，门诊组有 9 例（19.1%）并发症（P=0.648）。住院和门诊手术之间的术后并发症、返回急诊就诊和再次手术的频率没有显著差异（P>0.05）。年龄每增加 1 年，手术并发症的预测概率增加 14%（优势比=1.14；P=0.021），与手术环境无关。接受住院 TSA 的患者 90 天内再入院的频率显著较高（住院=16，门诊=1；P=0.034）。
门诊和住院 TSA 之间的术后并发症和急诊就诊返回没有显著差异。年龄每增加 1 年，手术并发症的概率增加 14%，无论手术环境如何。发现门诊 TSA 对年龄≥65 岁的适当选择的患者是安全的，应重新评估 TSA 作为仅住院手术的适应证。
