Borakati A, Ali A, Nagaraj C, Gadikoppula S, Kurer M. Day case vs inpatient total shoulder arthroplasty: A retrospective cohort study and cost-effectiveness analysis. World J Orthop 2020; 11(4): 213-221 [PMID: 32405470 DOI: 10.5312/wjo.v11.i4.213]
Corresponding Author of This Article
Aditya Borakati, BSc, MBBS, Doctor, Academic Foundation Doctor, Division of Surgery and Interventional Science, Royal Free Hospital and University College London, Pond Street, Hampstead, London NW3 2QG, United Kingdom. a.borakati@doctors.org.uk
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Apr 18, 2020; 11(4): 213-221 Published online Apr 18, 2020. doi: 10.5312/wjo.v11.i4.213
Day case vs inpatient total shoulder arthroplasty: A retrospective cohort study and cost-effectiveness analysis
Aditya Borakati, Asad Ali, Chetana Nagaraj, Srinivas Gadikoppula, Michael Kurer
Aditya Borakati, Division of Surgery and Interventional Science, Royal Free Hospital and University College London, London NW3 2QG, United Kingdom
Asad Ali, Srinivas Gadikoppula, Michael Kurer, Department of Trauma and Orthopaedics, North Middlesex University Hospital, London N18 1QX, United Kingdom
Chetana Nagaraj, Department of Anaesthesia, North Middlesex University Hospital, London N18 1QX, United Kingdom
Author contributions: Borakati A contributed to the design, data collection, analysis and wrote the manuscript; Nagaraj C and Gadikoppula S assisted with design of the study and data collection; Ali A and Kurer M reviewed the manuscript.
Institutional review board statement: This study was registered with the local clinical governance department at North Middlesex University Hospital as a service evaluation. No formal research ethics committee opinion was sought for this retrospective study with no alteration to patient care.
Informed consent statement: No informed consent was necessary for publication of anonymised results of this local service evaluation in line with local policies.
Conflict-of-interest statement: The authors confirm that there are no known conflicts of interest associated with this publication.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE checklist of items, and the manuscript was prepared and revised according to the STROBE checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Aditya Borakati, BSc, MBBS, Doctor, Academic Foundation Doctor, Division of Surgery and Interventional Science, Royal Free Hospital and University College London, Pond Street, Hampstead, London NW3 2QG, United Kingdom. a.borakati@doctors.org.uk
Received: November 11, 2019 Peer-review started: November 11, 2019 First decision: December 5, 2019 Revised: February 24, 2020 Accepted: March 12, 2020 Article in press: March 12, 2020 Published online: April 18, 2020 Processing time: 154 Days and 10.2 Hours
Abstract
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 United Kingdom centre.
AIM
To evaluate the efficacy and cost-effectiveness of day case 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 mo postoperatively; 30-d 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
Fifty nine patients were included, 18 d cases and 41 inpatients. There were no adverse events or re-admissions at 30 d postoperatively in either group. There were no significant differences in adjusted flexion (mean difference 16.4, 95%CI: 17.6-50.5, P = 0.337) or abduction (mean difference: 13.2, 95%CI: 18.4-44.9, P = 0.405) postoperatively between groups. Median savings with outpatient arthroplasty were £529 (interquartile range: 247.33-789, P < 0.0001).
CONCLUSION
Day case TSA is a safe, effective procedure, with significant cost benefit. Wider use may be warranted in the United Kingdom 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 £529.
