Outpatient revision shoulder arthroplasty can Be safe and effective: a matched analysis

Advances in anesthesia, perioperative pain management, and clearer criteria based on pre-operative risk factors have enabled a shift of primary shoulder arthroplasty to the outpatient setting with acceptable complication rates. However, as the incidence of revision shoulder arthroplasty increases, the safety of outpatient revision shoulder arthroplasty and appropriate indications for same-day discharge remain less clearly defined. The purpose of this study was to evaluate the safety of outpatient revision shoulder arthroplasty and establish pre and intraoperative criteria for appropriate same-day discharge.

All revision shoulder arthroplasty procedures performed at a single institution between 2015 and 2024 were retrospectively reviewed. Outpatient revision shoulder arthroplasty with ≥3-month follow-up were matched 1:1 with inpatient revision shoulder arthroplasties. Outpatient status was defined as surgeries performed at ambulatory surgery centers (ASCs) or with admission times ≤24 hours. Surgeries were matched by components explanted and implanted, age, and gender. Demographic data, comorbidities, revision surgery subtype, implant details, major/minor complications, readmissions, and patient-reported outcomes were recorded.

A total of 38 surgeries (19 inpatient and 19 outpatient) were retrospectively analyzed. Outpatients (mean age 61.84 ± 7.78 years) included both ASC (n = 9) and hospital-based cases (n = 10). Hospital-based outpatients had longer surgical times (169 vs. 101 minutes; P = .025) but similar comorbidities and American Society of Anesthesiologists distribution compared with ASC cases. Baseline characteristics between inpatient and outpatient cohorts were similar except higher smoking prevalence and American Society of Anesthesiologists ≥ III in inpatients (P = .021 and P = .029). In the outpatient group, 9 surgeries (47%) were full exchanges of all components, while the remainder underwent partial modular revisions (head, glenosphere, or polyethylene). At mean follow-up of 20.8 ± 19.3 months, outpatient patient-reported outcomes improved significantly across nearly all measures. Complications occurred in 9 outpatients (hematoma [5, 26%], stiffness [1, 5%], or persistent pain [3, 16%]), with 1 reoperation, compared to 9 inpatient complications and 3 reoperations. No outpatient readmissions occurred; 2 inpatient readmissions were recorded. Rates of minor and major complications did not significantly differ between cohorts (P = .754 and P = .625).

In this small, carefully selected cohort, outpatient revision shoulder arthroplasty can be safe and effective with complication profiles comparable to inpatient surgery.