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Is Day Case Shoulder Arthroplasty Safe?

India Cox, Nicola Doody, Stephen Hannah
University Hospital Wishaw, Wishaw, United Kingdom


Introduction: Demand for total shoulder arthroplasty (TSA) is increasing. Performing this as a day-case procedure has the potential to increase capacity. In the USA, 34.6% of all TSAs are day-case, but it is less common in the UK. We set out to establish whether day-case TSA is safe and efficient.

Methods: We performed a literature review, searching PubMed to identify all relevant literature on day-case TSA, and collating evidence regarding clinical outcomes, cost, and service development.
We then conducted a retrospective audit of all TSA patients in our centre over five years, looking at co-morbidities, length of stay (LOS), analgesia use, haemoglobin drop, acute kidney injury (AKI) and urinary retention.

Results: 49 articles were identified, almost all from the USA and published in the last five years. Analysis suggested day-case TSA has low complication and readmission rates, and high patient satisfaction. Postoperative pain may hinder same-day discharge in some patients. There are significant cost benefits.
63 patients underwent elective TSA 2015-2020 in our centre. Median LOS was two days (IQR 3) with no association between comorbidities and LOS. No patients required transfusion; 6% (n=4) developed a mild AKI; 3% (n=2) required catheterisation.

Conclusion: Evidence suggests day case TSA is safe and cost-effective for appropriately-selected patients. The vast majority of data comes from the USA; further work may need to be done in the UK to establish the benefits to the NHS. Our retrospective cohort had a low incidence of complications which supports the conclusion that same-day discharge is safe.