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Can we improve the day case rate for Total Shoulder Arthroplasty in Northumbria NHS Foundation Trust?

Leonie English1, Mike Blundell2, Fiona Ashton2, Jaime Candal-Couto2
1South Tyneside and Sunderland NHS Foundation Trust, Sunderland, United Kingdom. 2Northumbria Healthcare NHS Foundation Trust, Cramlington, United Kingdom


Introduction: The Department of Health has proposed a target of 75% of elective surgery to be day case [1].
Day case shoulder arthroplasty is still relatively novel procedure, with large studies quoting outpatient rates between 0.003-6% in the United States [2,3,4]. Northumbria Trust's have been consistently 9-10% since 2017.
We believe many of the patients going home on day one could go home the same day, therefore we looked at Northumbria’s upper limb arthroplasty’s (ULA) in order to propose a protocol for same-day ULA.

Methods: We looked at all ULAs performed in the Trust between between January 2020 and March 2021. Scrutinising a huge number of patient, social and surgical factors influencing their length of stay.

96 procedures in 93 patients were analysed.
17 trauma and 6 revision cases were excluded.
All patients received general and regional anaesthetic. 9% went home the same day, 58% home on day one, and 33% discharged on day two or later. No readmissions.
Notable favourable factors for same day discharge were:
• Regional anaesthesia essential
• Primary anatomical shoulder replacement
• Morning surgery
• ASA 1-2
• Any pre-operative anaemia optimised
• Distance from home to hospital site <30 miles
• Pre-operative patient education
• Occupational health requirements identified and addressed before surgery

Conclusions: Based on the factors found above, we are writing a protocol for Day Case Elective Shoulder Arthroplasty, with a target of 25% of ULAs to be day case.