Outpatient shoulder arthroplasty: An updated systematic review, meta-analysis, and trial sequential analysis on clinical outcomes and cost-effectiveness.

Abstract

Background: Outpatient shoulder arthroplasty has become increasingly popular in recent years. The aim of this study was to compare clinical outcomes and procedural costs between outpatient and inpatient shoulder arthroplasty.

Methods: Five databases were searched from their inception to November 7^th, 2024. Meta-analysis and trial sequential analysis were conducted to compare complications, readmission, revision surgery, and emergency department attendance between the two approaches. Procedural costs were reported descriptively.

Results: Thirty-four studies were included in the review. The meta-analysis revealed that medical complications (OR: 0.59, P = 0.0004) were significantly lower in the outpatient setting. No significant differences in total complications (OR: 0.74, P = 0.06), surgical complications (OR: 0.90, P = 0.59), readmission (OR: 1.08, P = 0.67), revision surgery (OR: 0.85, P = 0.15), or emergency department attendance (OR: 0.93, P = 0.68) were observed between the two approaches. The trial sequential analysis indicated that only the meta-analysis of total complications met the required information size to be considered conclusive and not at risk of random error. Outpatient surgery was associated with significantly lower procedural costs.

Conclusion: Outpatient shoulder arthroplasty is cost-effective and can yield non-inferior outcomes compared to the inpatient approach. However, further research is required to strengthen the evidence base.

Level of evidence: IV.