Outcomes of a UK day case shoulder arthroplasty pathway: Safety, patient satisfaction and cost-saving analysis.

Abstract

Background: Elective shoulder arthroplasty waiting list times are increasing. Day case shoulder arthroplasty (DCSA) could help address this. This study aimed to review the safety, cost savings and patient satisfaction of a DCSA pathway introduced in May 2021. Methods: All elective shoulder arthroplasties over three years (May 2021-2024) at a single centre were prospectively collected and retrospectively analysed. Two cohorts were compared: DCSA and inpatient. Primary outcomes were 90-day readmission and complication rates. Secondary outcomes were estimated cost savings and patient satisfaction using a locally developed non-validated questionnaire. Results: Of 102 shoulder arthroplasties, 25 were DCSA and 77 were inpatients. DCSA patients were significantly younger (mean age 64.8 vs. 73.6 years; p < 0.001) and more likely to have ASA I status (16% vs. 6%; odds ratio (OR) 2.74, 95% confidence interval (CI) 0.68-11.14; p = 0.04). There were no significant differences in 90-day complications (4% vs. 9%; OR 0.42, 95% CI 0.05-3.56; p = 0.42) or readmissions (0% vs. 2%; OR 0.42, 95% CI 0.05-3.56; p = 1.00). All DCSA patients reported treatment success and were six times more likely to recommend it. Estimated cost savings were 10,262.75, with 37,766.92 potentially saved if all patients had undergone DCSA. Conclusion: DCSA is safe, cost saving, and has high patient satisfaction. DCSA could be more widely adopted across the UK.