title: Development of a regional model of care for ambulatory total shoulder arthroplasty: a pilot study.
abstract: Total shoulder arthroplasty (TSA) has traditionally been performed as inpatient surgery to provide adequate postoperative analgesia via intermittent opioid administration. We developed a regional model for ambulatory TSA using continuous brachial plexus nerve block (CBPNB). We asked whether this regional model would allow us to select patients to undergo outpatient TSA using CBPNB while providing similar outcomes to those patients who were managed with CBPNB and a one-night or longer inpatient hospital stay. Of 16 selected patients, eight underwent outpatient TSA/CBPNB while the other eight had an overnight hospital stay. Outcome measures included readmission, duration of CBPNB use, pain scores, adjunctive analgesia use, range of motion, and patient satisfaction. There were no readmissions. Patients used CBPNB for an average of 6 days. The average postoperative pain score was 1/10. One patient required oral analgesics while using CBPNB. All patients were very satisfied (Likert scale) and would have the surgery again. Although these data are preliminary, the development of a regional outpatient model for TSA using CBPNB permitted integration of community care and patient satisfaction and decreased length of hospital stay.
  
  
  METHODS
  Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Rouge Valley Health System, 601 Harwood Avenue South, Ajax, Ontario, Canada. sgallay@mysmartsim.com
authors.forename: S H
authors.initials: SH
authors.lastname: Gallay
authors.forename: J J A
authors.initials: JJ
authors.lastname: Lobo
authors.forename: J
authors.initials: J
authors.lastname: Baker
authors.forename: K
authors.initials: K
authors.lastname: Smith
authors.forename: K
authors.initials: K
authors.lastname: Patel
mesh_terms: D000556:Ambulatory Surgical Procedures; D000698:Analgesia / Q000379:methods*; D000700:Analgesics / Q000627:therapeutic use; D001178:Arthroplasty; D001917:Brachial Plexus; D002985:Clinical Protocols; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D010865:Pilot Projects; D016730:Program Development; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D020069:Shoulder Pain / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000700:Analgesics