Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
J Shoulder Elbow Surg. 2022 Jul;31(7):1409-1415. doi: 10.1016/j.jse.2021.12.031. Epub 2022 Jan 26.
The COVID-19 (coronavirus disease 2019) pandemic has placed an increased burden on health care resources, with hospitals around the globe canceling or reducing most elective surgical cases during the initial period of the pandemic. Simultaneously, there has been an increased interest in performing outpatient total joint arthroplasty in an efficient manner while maintaining patient safety. The purpose of this study was to investigate trends in total shoulder arthroplasty (TSA) during the COVID-19 era with respect to outpatient surgery and postoperative complications.
We conducted a retrospective chart review of all primary anatomic and reverse TSAs performed at our health institution over a 3-year period (January 2018 to January 2021). All cases performed prior to March 2020 were considered the "pre-COVID-19 era" cohort. All cases performed in March 2020 or later comprised the "COVID-19 era" cohort. Patient demographic characteristics and medical comorbidities were also collected to appropriately match patients from the 2 cohorts. Outcomes measured included type of patient encounter (outpatient vs. inpatient), total length of stay, and 90-day complications.
A total of 567 TSAs met the inclusion criteria, consisting of 270 shoulder arthroplasty cases performed during the COVID-19 era and 297 cases performed during the pre-COVID-19 era. There were no significant differences in body mass index, American Society of Anesthesiologists score, smoking status, or distribution of pertinent medical comorbidities between the 2 examined cohorts. During the COVID-19 era, 31.8% of shoulder arthroplasties were performed in an outpatient setting. This was significantly higher than the percentage in the pre-COVID-19 era, with only 4.5% of cases performed in an outpatient setting (P < .0001). The average length of stay was significantly reduced in the COVID-19 era cohort (0.81 days vs. 1.45 days, P < .0001). There was a significant decrease in 90-day readmissions during the COVID-19 era. No significant difference in 90-day emergency department visits, 90-day venous thromboembolism events, or 90-day postoperative infections was observed between the 2 cohorts.
We found a significant increase in the number of outpatient shoulder arthroplasty cases being performed at our health institution during the COVID-19 era, likely owing to a multitude of factors including improved perioperative patient management and increased hospital burden from the COVID-19 pandemic. This increase in outpatient cases was associated with a significant reduction in average hospital length of stay and a significant decrease in 90-day readmissions compared with the pre-COVID-19 era. The study data suggest that outpatient TSA can be performed in a safe and efficient manner in the appropriate patient cohort.
COVID-19（冠状病毒病 2019）大流行给医疗资源带来了更大的负担，全球各地的医院在大流行的初期取消或减少了大多数择期手术病例。与此同时，人们越来越感兴趣的是以高效的方式进行门诊全关节置换术，同时保持患者安全。本研究旨在调查 COVID-19 时代全肩关节置换术（TSA）在门诊手术和术后并发症方面的趋势。
我们对我们医疗机构在 3 年期间（2018 年 1 月至 2021 年 1 月）进行的所有原发性解剖和反向 TSA 进行了回顾性图表审查。所有在 2020 年 3 月之前进行的病例均被视为“COVID-19 前时代”队列。所有在 2020 年 3 月或之后进行的病例均构成“COVID-19 时代”队列。还收集了患者的人口统计学特征和合并症，以便适当地将两个队列中的患者进行匹配。测量的结果包括患者就诊类型（门诊与住院）、总住院时间和 90 天并发症。
共有 567 例 TSA 符合纳入标准，其中 COVID-19 时代进行了 270 例肩部关节置换术，COVID-19 前时代进行了 297 例。两个检查队列之间在体重指数、美国麻醉医师协会评分、吸烟状况或相关合并症的分布方面没有显著差异。在 COVID-19 时代，31.8%的肩部关节置换术在门诊进行。这明显高于 COVID-19 前时代的百分比，只有 4.5%的病例在门诊进行（P<0.0001）。COVID-19 时代队列的平均住院时间明显缩短（0.81 天比 1.45 天，P<0.0001）。COVID-19 时代的 90 天再入院率显著下降。两个队列之间在 90 天急诊就诊、90 天静脉血栓栓塞事件或 90 天术后感染方面没有显著差异。
我们发现我们医疗机构在 COVID-19 时代进行的门诊肩部关节置换术数量显著增加，这可能是由于多种因素造成的，包括围手术期患者管理的改善和 COVID-19 大流行给医院带来的负担增加。与 COVID-19 前时代相比，门诊病例的增加与平均住院时间的显著缩短和 90 天再入院率的显著下降有关。研究数据表明，在适当的患者群体中，可以安全有效地进行门诊 TSA。
