From the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Mr. Agarwal, Dr. Xu, Dr. Best, and Dr. Srikumaran); the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC (Mr. Agarwal and Ms. Zhao); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wang); and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Ramamurti).
J Am Acad Orthop Surg Glob Res Rev. 2023 Nov 16;7(11). doi: 10.5435/JAAOSGlobal-D-23-00008. eCollection 2023 Nov 1.
There has been a trend toward performing arthroplasty in the ambulatory setting. The primary purpose of this study was to compare outpatient and inpatient total shoulder arthroplasties (TSAs) for postoperative medical complications, healthcare utilization outcomes, and surgical outcomes.
Patients who underwent outpatient TSA or inpatient TSA with a minimum 5-year follow-up were identified in the PearlDiver database. These cohorts were propensity-matched based on age, sex, Charlson Comorbidity Index, smoking status, and obesity (body mass index > 30). All outcomes were analyzed using chi square and Student t-tests where appropriate.
Outpatient TSA patients had markedly lower rates of various 90-day medical complications. Outpatient TSA patients had lower risk of aseptic loosening at 2 years postoperation and lower risk of periprosthetic joint infection at 5 years postoperation relative to inpatient TSA patients. Outpatient TSA reimbursements were markedly lower than inpatient TSA reimbursements at the 30-day, 90-day, and 1-year postoperative intervals.
This study found patients undergoing outpatient TSA to be at lowers odds for both postoperative medical and surgical complications compared with those undergoing inpatient TSA. Despite increased risk of postoperative healthcare utilization for readmissions and emergency department visits, outpatient TSA was markedly less expensive at every postoperative time point assessed.
在门诊环境中进行关节置换术已成为一种趋势。本研究的主要目的是比较门诊和住院全肩关节置换术（TSA）的术后医疗并发症、医疗保健利用结果和手术结果。
在 PearlDiver 数据库中确定了接受门诊 TSA 或住院 TSA 治疗且随访时间至少为 5 年的患者。这些队列基于年龄、性别、Charlson 合并症指数、吸烟状况和肥胖（BMI>30）进行倾向匹配。使用适当的卡方检验和学生 t 检验分析所有结果。
门诊 TSA 患者在 90 天内发生各种医疗并发症的风险明显较低。与住院 TSA 患者相比，门诊 TSA 患者在术后 2 年发生无菌性松动的风险较低，在术后 5 年发生假体周围关节感染的风险较低。与住院 TSA 相比，门诊 TSA 的报销费用在术后 30 天、90 天和 1 年时明显较低。
本研究发现，与住院 TSA 相比，门诊 TSA 患者术后发生医疗和手术并发症的几率较低。尽管术后再入院和急诊就诊的医疗保健利用率增加，但在评估的每个术后时间点，门诊 TSA 的费用明显更低。
