Reverse total shoulder arthroplasty for proximal humerus fractures as an outpatient procedure

The purpose of this study is to compare short-term outcomes, including complication rates, readmissions, and reoperations, between inpatient and outpatient reverse total shoulder arthroplasty (rTSA) performed for proximal humerus fractures.

All rTSA performed for proximal humerus fractures from January 2020 to January 2025 were retrospectively analyzed. Patients were evaluated based on whether they had the surgery performed as an inpatient (at least 1 overnight hospital stay) or as an outpatient (discharged on the same day as surgery). The decision for inpatient versus outpatient surgery was based on the surgeon's discretion. Complications within the first 30 and 90 days, including readmission and reoperation, were compared between the 2 groups, and a P value of <0.05 was considered to be statistically significant.

A total of 131 rTSAs for proximal humerus fractures were performed during the study period. Fifty-four patients underwent outpatient surgery and 77 patients underwent inpatient surgery. Average age in the outpatient group was 72.0 ± 6.8 years compared to inpatient 75.1 ± 9.7 years (P = .043). There were no significant differences in remaining patient demographics. Of the surgeries completed in the inpatient setting, the average length of stay was 4.75 ± 5.9 (range 1-44 days). There were no significant differences in the rates of emergency department (ED) visits that may be reasonably related to surgery within 90 days (18.5% vs. 18.2%; P = 1.000). Common reasons for ED visits included pain, wound complications, gastrointestinal diagnoses, and urinary tract infections. Patients who underwent outpatient rTSA showed no statistically significant difference in 90-day readmission rates compared to inpatient rTSA (3.7% vs. 13.0%; P = .121). Common reasons for readmission included cardiopulmonary complications. No patient in either cohort required further surgical intervention in the first 90 days following surgery.

rTSA for proximal humerus fractures can be safely performed in the outpatient setting for appropriately selected patients, with no significant differences in 30-day or 90-day ED visits, readmission, or reoperations compared to inpatient management. Careful patient selection, incorporating medical and social factors, may allow for expanded use of outpatient pathways while maintaining patient safety.