Title : Day-case shoulder arthroplasty: potential for improved efficiency and cost reduction in an NHS elective cohort
Abstract:
Introduction: The demand for shoulder arthroplasty has tripled over the last decade and is continuing to grow at a rate greater than that of hip or knee. Innovative and resource efficient strategies are needed to meet this growing demand and although Enhanced Recovery and same-day discharge arthroplasty pathways have been successfully implemented across the world, Day-Case Shoulder Arthroplasty (DCSA) has remained difficult to achieve at the same rate in the United Kingdom.
Methods: We conducted a retrospective evaluation of elective shoulder arthroplasties done in our centre between January 2024 and April 2025 to gather information on Length Of Stay (LOS), complications and potential for improvement in contemporary elective shoulder arthroplasty NHS cohorts. We analysed patient characteristics, LOS, complications and factors contributing to delayed discharge, and compared our current performance with established DCSA pathways to identify opportunities for improvement and potential cost savings associated with implementing a DCSA pathway at our centre.
Results: A total of 54 patients were evaluated. Mean age was 72.9 years. Most patients were ASA II (n=36, 66.7%). Mean LOS was 2.7 days. 50% were discharged after a one-day stay, 20.4% stayed 2 days as inpatients and 29.6% required stays of 3days or more. Adherence to existing DCSA pathways would have allowed for same-day discharge of 35.1% of patients. Analysis of these patients showed that the main factor contributing to their stay in hospital (1.52 day avg. LOS) was timing of investigations and assessments and not medical necessity. In patients not fit for DCSA, the completion of post-op investigations and assessments, was still the main factor prolonging their inpatient stay beyond 1 day. Other factors leading to increased LOS were minor complications such as pain, anaemia, hyponatraemia, hypotension or social factors. Readmissions were rare (n=1, 1.4%).
Conclusion: Elective shoulder arthroplasty can be safely delivered with short LOS or same-day discharge. Enhanced preoperative assessment, early physiotherapy and imaging, and streamlined discharge planning have the potential to significantly improve efficiency, bed utilization and reduce costs to the NHS.
