Malahias Michael-Alexander, Kokkineli Stefania, Gu Alex, Karanikas Dimitris, Kaar Scott G, Antonogiannakis Emmanouil
The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA.
3rd Orthopaedic Department, HYGEIA Hospital, Athens, Greece.
Shoulder Elbow. 2021 Oct;13(5):471-481. doi: 10.1177/1758573220944411. Epub 2020 Aug 26.
A number of papers have been published comparing the safety and efficacy of day case and inpatient anatomic or reverse total shoulder arthroplasty. However, no systematic review of the literature has been published to date. The aim of this review was to determine if day case total shoulder arthroplasty (length of stay <24 h) leads to similar outcomes as standard-stay inpatients (length of stay ≥24 h).
The US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviewers were queried for publications utilizing keywords that were pertinent to total shoulder arthroplasty, day case, outpatient and inpatient, clinical or functional outcomes, and complications. In order to determine the quantitative impact of day case total shoulder arthroplasty on readmission and revision rate, a meta-analysis was performed on articles that observed 30- or 90-day readmission or revision.
Eight articles were found to be suitable for inclusion in the present study which included 6103 day case total shoulder arthroplasty and 147,463 inpatient total shoulder arthroplasty. Following meta-analysis, there was no significant difference among patients who underwent day case total shoulder arthroplasty compared to inpatient total shoulder arthroplasty regarding revision rates (OR: 1.001; 95% CI: 0.721-1.389; p = 0.995) and 30-day readmission rates (OR: 0.940; 95% CI: 0.723-1.223; p = 0.646). In contrast, patients who underwent day case total shoulder arthroplasty were less likely to have a readmission within 90 days compared to their inpatient counterparts (OR: 0.839; 95% CI: 0.704-0.999; p = 0.049). Two out of eight studies reported comparable baseline clinical characteristics among groups, while five studies reported significant differences and one study did not provide information regarding clinical characteristics, such as medical comorbidities or American Society of Anaesthesiologists'(ASA) score. No significant difference among groups was found in all or almost all studies regarding mortality rates, and rates of cardiac complications, cerebrovascular events, thromboembolic events, pulmonary complications, cardiac complications, and nerve complications. Finally, results were rather conflicting regarding the correlation of day case total shoulder arthroplasty to the rate of surgical site infections.
This study showed that day case total shoulder arthroplasty might lead to similar rates of mortality, complications, revisions, and readmissions compared to inpatient total shoulder arthroplasty when used in a selected population of younger, healthier, and more male patients. In contrast, there was no consensus regarding the impact of day case total shoulder arthroplasty on the rate of surgical site infections. Finally, further research of higher quality is required to establish patient demographic criteria, ASA score, or comorbidity index cut off that might be used to define day case-treated patients who seem to have equivalent outcomes compared to inpatient-treated patients. Systematic review of level III studies (lowest level included).
已有多篇论文比较了日间手术与住院手术行解剖型或反式全肩关节置换术的安全性和疗效。然而，迄今为止尚未发表对该文献的系统评价。本评价的目的是确定日间手术全肩关节置换术（住院时间<24小时）是否能产生与标准住院患者（住院时间≥24小时）相似的结果。
查询美国国立医学图书馆（PubMed/MEDLINE）、EMBASE和Cochrane系统评价数据库，检索与全肩关节置换术、日间手术、门诊和住院患者、临床或功能结局及并发症相关的关键词的出版物。为了确定日间手术全肩关节置换术对再入院率和翻修率的定量影响，对观察30天或90天再入院或翻修情况的文章进行荟萃分析。
发现8篇文章适合纳入本研究，其中包括6103例日间手术全肩关节置换术和147463例住院全肩关节置换术。荟萃分析后，与住院全肩关节置换术相比，接受日间手术全肩关节置换术的患者在翻修率（比值比：1.001；95%置信区间：0.721 - 1.389；p = 0.995）和30天再入院率（比值比：0.940；95%置信区间：0.723 - 1.223；p = 0.646）方面无显著差异。相比之下，与住院患者相比，接受日间手术全肩关节置换术的患者在90天内再入院的可能性较小（比值比：0.839；95%置信区间：0.704 - 0.999；p = 0.049）。8项研究中有2项报告了各组间可比的基线临床特征，5项研究报告了显著差异，1项研究未提供关于临床特征的信息，如合并症或美国麻醉医师协会（ASA）评分。在所有或几乎所有研究中，各组在死亡率、心脏并发症、脑血管事件、血栓栓塞事件、肺部并发症、心脏并发症和神经并发症发生率方面均未发现显著差异。最后，关于日间手术全肩关节置换术与手术部位感染率的相关性，结果相当矛盾。
本研究表明，在选定的年轻、健康且男性患者群体中，日间手术全肩关节置换术与住院全肩关节置换术相比，可能导致相似的死亡率、并发症、翻修率和再入院率。相比之下，关于日间手术全肩关节置换术对手术部位感染率的影响尚无共识。最后，需要进行更高质量的进一步研究，以确定可用于定义与住院治疗患者似乎有等效结局的日间手术治疗患者的患者人口统计学标准、ASA评分或合并症指数临界值。Ⅲ级研究的系统评价（纳入的最低级别）。
