Jennewine Brenton R, Throckmorton Thomas W, Pierce Andrew S, Miller Andrew H, Azar Adrian T, Sharp Chris D, Azar Frederick M, Bernholt David L, Brolin Tyler J
Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA.
College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
J Shoulder Elbow Surg. 2024 Apr;33(4):900-907. doi: 10.1016/j.jse.2023.07.018. Epub 2023 Aug 23.
Outpatient total shoulder arthroplasty (TSA) presents a safe alternative to inpatient arthroplasty, while helping meet the rapidly rising volume of shoulder arthroplasty needs and minimizing health care costs. Identifying the correct patient for outpatient surgery is critical to maintaining the safety standards with TSA. This study sought to update an ambulatory surgery center (ASC) TSA patient-selection algorithm previously published by our institution.
A retrospective chart review of TSAs was performed in an ASC at a single institution to collect patient demographics, perioperative risk factors, and postoperative outcomes with regard to reoperations, hospital admissions, and complications. The existing ASC algorithm for outpatient TSA was altered based on collected perioperative information, review of pertinent literature, and anesthesiology recommendations.
A total of 319 TSAs were performed in an ASC in 298 patients over 7 years. Medically related complications occurred in 3 patients (0.9%) within 90 days of surgery, 2 of whom required hospital admission (0.6%) for acute kidney injury and pulmonary embolus. There were no instances of major cardiac events. Orthopedic-related complications occurred in 11 patients (3.4%), with hematoma development requiring evacuation and instability requiring revision being the most common causes.
There was a low rate of perioperative complications and hospital admissions, confirming the safety of TSAs in an ASC setting. Based on prior literature and the population included, a pre-existing patient-selection algorithm was updated to better reflect increased comfort, knowledge, and data regarding safe patient selection for TSA in an ASC.
门诊全肩关节置换术（TSA）是住院关节置换术的一种安全替代方案，有助于满足快速增长的肩关节置换需求，并将医疗成本降至最低。确定适合门诊手术的患者对于维持TSA的安全标准至关重要。本研究旨在更新我们机构之前发布的门诊手术中心（ASC）TSA患者选择算法。
在单一机构的ASC中对TSA进行回顾性病历审查，以收集患者人口统计学、围手术期风险因素以及再次手术、住院和并发症方面的术后结果。根据收集到的围手术期信息、相关文献回顾和麻醉学建议，对现有的ASC门诊TSA算法进行了修改。
7年间，在一个ASC中对298例患者进行了总共319例TSA。3例患者（0.9%）在术后90天内发生与医疗相关的并发症，其中2例因急性肾损伤和肺栓塞需要住院（0.6%）。未发生重大心脏事件。11例患者（3.4%）发生与骨科相关的并发症，最常见的原因是血肿形成需要引流以及不稳定需要翻修。
围手术期并发症和住院率较低，证实了在ASC环境中TSA的安全性。基于先前的文献和纳入的人群，对现有的患者选择算法进行了更新，以更好地反映在ASC中进行TSA安全患者选择方面舒适度、知识和数据的增加。
