背景:先前的研究已经证明了门诊全肩关节置换术(TSA)的安全性和成本效益,大多数研究集中在90日结局和并发症。患者选择算法有助于为门诊TSA设置适当地选择患者。这项研究旨在确定门诊和住院队列之间TSA的结果,并进行至少2年的随访。
方法:回顾性研究确定了18岁以上接受TSA的患者,在住院或门诊患者中至少随访2年。使用先前发布的门诊TSA患者选择算法,患者被分为三组:门诊患者,因保险要求住院,由于不符合算法标准而住院。评估的结果包括视觉模拟量表(VAS)疼痛,美国肩肘外科医师(ASES)评分,单项评估数字评估(SANE)得分,运动范围(ROM),力量,并发症,重新录取,和重新运营。在门诊和住院组之间进行分析,以证明门诊TSA的安全性和有效性以及中期随访。
结果:本研究共纳入779份TSA,分配到门诊(N=108),因保险住院(N=349),由于算法而住院(N=322)。两组患者的平均年龄差异有统计学意义(分别为59.4±7.4、66.5±7.5和72.5±8.7;P<0.0001)。所有患者组在术前至最终患者预后评分方面均表现出显着改善,ROM,和力量。队列之间的分析显示相似的最终随访结果得分,ROM,和力量,几乎没有临床上可能没有差异的显著差异,无论手术位置如何,保险状况,或满足患者选择算法。并发症,重新操作,三组之间的再入院没有显著差异.
结论:本研究重申了先前的短期随访文献。与中期随访的住院队列相比,将适当的患者转移到门诊TSA会产生相似的结果和并发症。
BACKGROUND: Previous studies have demonstrated the safety and cost-effectiveness of outpatient total shoulder arthroplasty (TSA), with the majority of studies focusing on 90-day
outcomes and complications. Patient selection algorithms have helped appropriately choose patients for an outpatient TSA setting. This study aimed to determine the
outcomes of TSA between outpatient and inpatient cohorts with at least a 2-year follow-up.
METHODS: A retrospective review identified patients older than 18 years who underwent a TSA with a minimum of 2-year follow-up in either an inpatient or outpatient setting. Using a previously published outpatient TSA patient-selection algorithm, patients were allocated into three groups: outpatient, inpatient due to insurance requirements, and inpatient due to not meeting algorithm criteria.
Outcomes evaluated included visual analog scale (VAS) pain, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, range of motion (ROM), strength, complications, re-admissions, and re-operations. Analysis was performed between the outpatient and inpatient groups to demonstrate the safety and efficacy of outpatient TSA with midterm follow-up.
RESULTS: A total of 779 TSA were included in this study, allocated into the outpatient (N = 108), inpatient due to insurance (N = 349), and inpatient due to algorithm (N = 322). The average age between these groups was significantly different (59.4 ± 7.4, 66.5 ± 7.5, and 72.5 ± 8.7, respectively; P < 0.0001). All patient groups demonstrated significant improvements in preoperative to final patient-
outcomes scores, ROM, and strength. Analysis between cohorts showed similar final follow-up outcome scores, ROM, and strength, with few significant differences that are likely not clinically different, regardless of surgical location, insurance status, or meeting patient-selection algorithm. Complications, reoperations, and readmissions between all three groups were not significantly different.
CONCLUSIONS: This study reaffirms prior short-term follow-up literature. Transitioning appropriate patients to outpatient TSA results in similar
outcomes and complications compared to inpatient cohorts with mid-term follow-up.