Analysis of 90-Day Complications in Outpatient Total Shoulder Arthroplasty

There is limited data documenting the safety and clinical outcomes following outpatient total shoulder arthroplasty (TSA) and reverse TSA (RTSA) compared to inpatient shoulder arthroplasty. It was hypothesized that there would be no significant differences in complication and ER visit rate between outpatient TSA and RTSA. A prospectively maintained institutional registry was retrospectively queried for all patients undergoing primary TSA or RTSA between September 2016 and April 2019 and confirmed as having undergone outpatient surgery, defined as surgery performed at an ambulatory surgery center (ASC). Ninety-day complications, readmissions, and emergency room (ER) visits were analyzed for outpatient TSA and RTSA. The 90-day complications included infection, thromboembolic disease (pulmonary embolism, deep venous thrombosis), neurovascular injury, revision surgery, and inflammatory processes. A total of 140 patients were identified that underwent outpatient TSA or RTSA from 2016 to 2019. Four complications (3.7%) were reported in the TSA cohort, compared to four complications (12.9%) reported in the RTSA cohort (P = 0.060). Three ER visits occurred in the RTSA group compared to 0 in the TSA group (P = 0.001). Patients who experienced a complication had significantly higher BMI (TSA: P = 0.049, RTSA: P = 0.035). In addition, there were no readmissions or reoperations in either TSA or RTSA patients. Overall, the rate of complications, ER visits, and readmission rates in outpatient TSA and RTSA was found to be relatively low given the sample size of this study and minor complications reported. In addition, there were no readmissions or reoperations in either TSA or RTSA patients. Elevated BMI may significantly increase the risk of complications after both a TSA and RTSA. This study suggests that outpatient TSA and RTSA is safe in select patients.