This matched cohort study asks whether anatomic total shoulder arthroplasty can be done safely as a same-day outpatient procedure. It compares 90-day episode-of-care complications for 30 patients treated at a freestanding ambulatory surgery center against 30 age- and comorbidity-matched inpatients. It is the first study to directly compare ASC versus hospital TSA on admissions, reoperations, and complications.
When a healthy, younger patient needs anatomic TSA, same-day discharge from an ambulatory surgery center is a reasonable option, not a compromise in safety. This study delivered equivalent 90-day complication rates (13% vs 10%) with no admissions, readmissions, or reoperations in either arm.
The mechanism that makes this work is selection. Both surgeon and anesthesiologist screened every candidate for age, comorbidity burden, and prior cardiac events, and there were zero cardiopulmonary complications. Weight the evidence carefully. This is a Level III retrospective single-surgeon series of 60 patients, and the ASC group was younger (mean 52.6 years) than a typical TSA population.
The takeaway is not that all TSA can move outpatient, but that a carefully vetted subset can be safely offered same-day surgery. Cost-effectiveness and functional outcomes were not assessed and remain open questions.
Neer Award 2016: Outpatient Total Shoulder Arthroplasty in an Ambulatory Surgery Center Is a Safe Alternative to Inpatient Total Shoulder Arthroplasty in a Hospital: a Matched Cohort Study
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This matched cohort study asks whether anatomic total shoulder arthroplasty can be done safely as a same-day outpatient procedure. It compares 90-day episode-of-care complications for 30 patients treated at a freestanding ambulatory surgery center against 30 age- and comorbidity-matched inpatients. It is the first study to directly compare ASC versus hospital TSA on admissions, reoperations, and complications.
When a healthy, younger patient needs anatomic TSA, same-day discharge from an ambulatory surgery center is a reasonable option, not a compromise in safety. This study delivered equivalent 90-day complication rates (13% vs 10%) with no admissions, readmissions, or reoperations in either arm.
The mechanism that makes this work is selection. Both surgeon and anesthesiologist screened every candidate for age, comorbidity burden, and prior cardiac events, and there were zero cardiopulmonary complications. Weight the evidence carefully. This is a Level III retrospective single-surgeon series of 60 patients, and the ASC group was younger (mean 52.6 years) than a typical TSA population.
The takeaway is not that all TSA can move outpatient, but that a carefully vetted subset can be safely offered same-day surgery. Cost-effectiveness and functional outcomes were not assessed and remain open questions.