Day case versus inpatient total shoulder arthroplasty: A retrospective cohort study and cost-effectiveness analysis

Background Day case total shoulder arthroplasty (TSA) is a novel approach, not widely practiced in Europe. We conducted a retrospective cohort study of patients comparing elective day case and inpatient TSAs in our UK centre. Aim To evaluate the efficacy and cost-effectiveness of day case total shoulder arthroplasty (TSA) compared to standard inpatient total shoulder arthroplasty. Methods All patients undergoing TSA between January 2017 and July 2018 were included. Outcome measures were: change in abduction and extension 3 months postoperatively; 30 day postoperative adverse events and re-admissions in day case and inpatient groups. We also conducted an economic evaluation of outpatient arthroplasty. Multivariate linear and logistic regression were used to adjust for demographic and operative covariates. Results 59 patients were included, 18 day cases and 41 inpatients. There were no adverse events or re-admissions at 30 days postoperatively in either group. There were no significant differences in adjusted flexion (mean difference 16.4°; 95% CI -17.6° to 50.5°, p=0.337) or abduction (mean difference 13.2° 95% CI; -18.4° to 44.9°, p=0.405) postoperatively between groups. Median savings with outpatient arthroplasty were GBP 529 (IQR 247.33 to 789, p<0.0001). Conclusion Day case TSA is a safe, effective procedure, with significant cost benefit. Wider use may be warranted in the UK and beyond, with potential for significant cost savings and improved efficiency. Core tip In this article we show that day case total shoulder arthroplasty is a feasible, safe and effective alternative to inpatient admission for the same procedure, with an associated average cost saving of GBP 529.