A worldwide cross-sectional survey seeks the current global practice patterns on perioperative management in elective...

Perioperative management in elective shoulder arthroplasty varies widely, with no universal consensus on best practices. This study aimed to characterize current global standards of perioperative care, including pre-operative, intraoperative, and post-operative management, among orthopedic surgeons performing elective shoulder replacement surgery, with the aim of contributing to a global standard of care.

A comprehensive online questionnaire was designed and anonymously distributed to orthopedic societies on each continent. Participants were cross-sectionally surveyed with the goal of identifying current global pre-operative, intraoperative, and post-operative practices in patient care and discharge management.

Eighteen societies from 5 continents participated in the survey. A total of 977 orthopedic surgeons completed the online questionnaire. The data analysis reveals that routine pre-operative advanced imaging studies are not standard with either computed tomography scan (50%) or magnetic resonance imaging scan (39%) preferred. Pre-operative planning software was not routinely used (31%). A chlorhexidine wash is part of the presurgical preparation for 52% of participants, but 23% do no prewash. Beach-chair or lazy beach-chair is the preferred surgical position (99%), and the deltopectoral approach remains the most standard approach (91%). Perioperative antibiotic use is nearly universal (99%), whereas routine tranexamic acid use remains moderate (43%). Post-operative sling use varies from 4-6 weeks including range of motion restrictions. Same-day surgery accounts for only 4% of discharge practices, while 32% discharge on the first post-operative day. Sixty-four percent of respondents discharge patients after several in-hospital nights.

Survey data show marked homogeneity in intraoperative practices (eg, surgical approach, patient positioning, and antibiotic use). However, pre-operative and post-operative survey results, including planning software use, post-operative immobilization, and discharge times, showed substantial variation. These findings highlight the need for further research and consensus to establish evidence-based perioperative protocols in elective shoulder replacement surgery.