Outpatient Shoulder Surgery

Total shoulder replacement (both anatomic and reverse) has traditionally been performed in the inpatient (hospital) setting. Over the past 15 years, hip and knee replacement surgeons have transitioned gradually from inpatient surgery to more and more patients having either same day discharge or overnight stay only. Total shoulder replacement surgeons have followed suit by shortening stays for these procedures in the appropriate patient. The following summary introduces the concept of outpatient total shoulder replacement, describes the strategies employed to shorten the hospital stay, and criteria for an ideal candidate for a same day or next day (23 hour stay) discharge.

Total shoulder replacement involves replacing the shoulder joint with metal and plastic components.  The surgery is performed through an incision on the front of the shoulder and typically takes between 2 and 3 hours. The degree of difficulty of the operation and the duration of the operation can vary from patient to patient based on patient anatomy, size, and disease severity. For example, severe bone loss, stiffness, medical conditions that create health risks (‘comorbidities’ such as diabetes or heart conditions), and obesity are all reasons to consider an inpatient surgery rather than outpatient shoulder replacement.  

Preoperative planning along with patient education and expectations are critical for the success of outpatient shoulder replacement so the patient understands what is ‘normal’ and what to expect. Similarly, surgical planning by the surgeon can help shorten operative time. 

Anesthetic improvements have facilitated outpatient total shoulder arthroplasty. Often, multiple types of medications can be given preoperatively and postoperatively to minimize the need for narcotic medications. Similarly, nerve block anesthesia where a catheter is inserted to administer local anesthetic to keep the shoulder numb for 2-3 days has become the standard of care. 

Before surgery

• Patient education: sling, therapy, precautions, expectations
• Surgeon planning
• Early surgical start
• Preoperative medications
• Regional block with scalene catheter for pain control

During surgery

• Bleeding control medication
• Periarticular injection of local anesthetics
• Minimize operation duration

After surgery

• Home medications filled in advance
• Cryotherapy (cold device/ice pack)
• Physical therapy visit for mobility and sling assistance
• Communication plan for postoperative questions
• Action plan if re-evaluation needed prior to postop visit

Outpatient total shoulder replacement surgery in a qualified, motivated and properly prepared patient can be successful. A multi-disciplinary team based approach with a defined pathway is key to success.

This involves:

1. patient education before surgery
2. expert regional anesthesia care with multi-type pain medicines
3. surgical team preparation and proper patient selection
4. nursing and physical therapy support postoperatively

Patients need to talk to their surgeons to determine whether or not they are candidates for outpatient or short length of stay for shoulder surgery. You may also want to talk with your insurance company prior to surgery to see if outpatient surgery is covered in your benefits.