Mastrokostas Paul G, Harounian Joshua, Tabbaa Ameer, Voyvodic Lucas, Horn Andrew, Ng Mitchell K, Sadeghpour Ramin, Razi Afshin E, Choueka Jack
Department of Orthopaedic Surgery, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA.
Eur J Orthop Surg Traumatol. 2025 Mar 27;35(1):136. doi: 10.1007/s00590-025-04253-0.
The rising demand for primary total shoulder arthroplasty (TSA) has spurred interest in comparing the safety and cost-effectiveness of outpatient TSA in ambulatory surgical centers (ASCs) versus hospital-based centers (HSCs). This study evaluates ASCs and HSCs for medical complications, readmission rates, implant complications, and costs.
This retrospective cohort study used the PearlDiver Mariner Database to identify patients undergoing primary TSA in ASCs or HSCs, assessing medical complications, readmissions, implant issues, and costs. ASC patients were matched in a 1:5 ratio to HSC patients by age, sex, region, and Elixhauser Comorbidity Index (ECI). Logistic regression analyzed the impact of ASC versus HSC settings on complications and readmissions, while Welch's t-tests compared costs. Statistical significance was determined by a P value less than or equal to 0.05.
ASCs showed lower odds of pulmonary embolism (OR = 0.69; P = 0.04), total medical complications (OR = 0.89; P = 0.01), prosthetic joint dislocation (OR = 0.43; P = 0.05), and total implant-related complications (OR = 0.85; P = 0.03), but a higher 90-day readmission rate (OR = 1.22; P < 0.01). ASCs also offered significant cost savings on the day of surgery ($4600 vs. $11,100; P < 0.01) and for 90-day total costs ($6600 vs. $13,500; P < 0.01) compared to HSCs.
Outpatient primary TSA in ASCs offers comparable safety with substantially lower costs than HSCs. Despite higher readmission rates, ASCs represent a viable, cost-effective alternative.
对初次全肩关节置换术（TSA）的需求不断增加，引发了人们对比较门诊手术中心（ASC）与医院中心（HSC）进行门诊TSA的安全性和成本效益的兴趣。本研究评估了ASC和HSC的医疗并发症、再入院率、植入物并发症及成本。
这项回顾性队列研究使用PearlDiver Mariner数据库识别在ASC或HSC接受初次TSA的患者，评估医疗并发症、再入院情况、植入物问题及成本。按年龄、性别、地区和埃利克斯豪泽合并症指数（ECI）以1:5的比例将ASC患者与HSC患者进行匹配。逻辑回归分析ASC与HSC环境对并发症和再入院的影响，而韦尔奇t检验比较成本。通过P值小于或等于0.05确定统计学显著性。
ASC发生肺栓塞的几率较低（OR = 0.69；P = 0.04）、总体医疗并发症较低（OR = 0.89；P = 0.01）、人工关节脱位较低（OR = 0.43；P = 0.05）以及与植入物相关的总体并发症较低（OR = 0.85；P = 0.03），但90天再入院率较高（OR = 1.22；P < 0.01）。与HSC相比，ASC在手术当天也显著节省成本（4600美元对11100美元；P < 0.01）以及90天总成本（6600美元对13500美元；P < 0.01）。
ASC进行的门诊初次TSA与HSC相比安全性相当，但成本大幅降低。尽管再入院率较高，但ASC是一种可行的、具有成本效益的选择。
