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.

Keywords

Shoulder arthroplasty day case shoulder arthroplasty shoulder replacement ambulatory shoulder replacement outpatient shoulder arthroplasty

Introduction

Incidence of shoulder arthroplasty has continued to rise at a significant rate. Between 2012 and 2020, almost 40,000 elective shoulder arthroplasty procedures were undertaken in the UK and the annual incidence is predicted to continue to rise by 12% per year in patients over 55 years old.^1,2 Shoulder arthroplasty is a successful treatment for glenohumeral arthritis (OA), rheumatoid arthritis, cuff tear arthropathy, irreparable massive rotator cuff tear without OA and trauma. Arthroplasty options include anatomical total shoulder replacement (TSR), reverse polarity shoulder replacement (RSR) and hemiarthroplasty (HA).

The National Health Service (NHS) waiting lists are at an all-time high, with over 800,000 patients waiting for elective orthopaedic surgery in 2023.³ There has been a drive for day case hip and knee arthroplasty across the UK, and day case shoulder arthroplasty (DCSA) has been widely adopted in the US.^4–6 However, there is little reported in the literature on DCSA in the UK. In fact, a recent literature review found only 39 cases of DCSA performed outside of the US.⁴ DCSA could help tackle waiting lists, deliver cost savings by reducing hospital bed days, and is associated with high patient satisfaction.⁴

In May 2021, the authors described and introduced an evidence-based DCSA pathway. This was compiled by a contemporary literature review and input from the local perioperative multidisciplinary team. In this study, we aimed to review the success of this pathway in terms of safety, cost savings and patient satisfaction.

Methods

A retrospective cohort study was conducted on all patients undergoing elective primary shoulder arthroplasty (TSR, RSR, or HA) at a single elective hospital in the UK over a three-year period from 1 May 2021 (date DCSA pathway introduced) until 31 May 2024. Data were prospectively collected and retrospectively analysed. Operations were performed by three fellowship-trained consultant shoulder surgeons. All patients had a minimum of 90-day follow-up. Patients were seen routinely at 2 weeks, 6 weeks, 6 months and 12 months postoperatively. Clinical and radiological review was performed at these time points. Patients were excluded if performed for acute trauma or revision arthroplasty.

Patients were categorised as either DCSA or inpatient. DCSA patients were defined as patients discharged on the same calendar day as their operation, and any patients who stayed in the hospital overnight or had a ‘23 h’ stay were excluded. The DCSA pathway was previously described and published in this journal (see Figure 1).⁷ All day case patients followed this standardised evidence-based protocol, which includes pre-operative assessment, anaesthetic guidelines, discharge criteria and post-operative follow-up.

Primary outcomes were 90-day complication rates and 90-day readmission rates. Secondary outcomes included patient satisfaction and estimated cost savings. Patient satisfaction was assessed via telephone questionnaires (Appendix 1 in online supplementary material). An economic evaluation was conducted based on the most recent cost estimates quoted by NHS England.⁸ Cost savings are presented in British pound sterling (£) and based on hospital bed days saved. Other costs were assumed neutral between the groups.

All cases were performed with a single-shot ultrasound-guided peripheral nerve block under general anaesthetic, in a beach chair position, through the deltopectoral approach with subscapularis tenotomy. At induction, intravenous tranexamic acid and prophylactic antibiotics were given in the form of Teicoplanin and Gentamicin as per local microbiology guidelines.

Statistical analysis was performed by a medical statistician using the software R v4.4.1 (R Core Team, 2025, Vienna, Austria).⁹ Descriptive data are presented as mean and standard deviation (SD) for continuous variables. Categorical variables are presented as frequencies and proportions, with the effect size of categorical outcomes presented as odds ratios (ORs) with 95% confidence intervals (CIs). DCSA and inpatient groups were compared using Welch's t-tests, x² and Fisher's exact tests.

Multivariable logistic or linear regression was used to model group as a predictor of the above outcomes, additionally adjusting for demographic and clinical factors that significantly differed between groups (Table 1) – namely procedure type, age, and ASA score (acuity). Note for day 1 post-op pain outcome, day 0 pain ratings were also adjusted for. Any 90-day readmission was not modelled due to a zero-event rate among day cases.

Table 1.

Rates of 90-day complications and readmissions across the DCSA and inpatient cohorts, including management received.

Primary outcomes		DCSA	Inpatient	Difference	Management
90-day complications (n, %)	Total	1 (4%)	7 (9%)	p = 0.411 (x²)
	Radial nerve neuropraxia	0 (0%)	1 (1%)		Conservative
	Axillary nerve neuropraxia	1 (1%)	0 (0%)		Conservative
	Brachial plexus neuropraxia	0 (0%)	1 (1%)		Conservative
	Dislocation	0 (0%)	1 (1%)		Revision
	Post-op haematoma	0 (0%)	2 (3%)		Conservative
	Anaemia	0 (0%)	1 (1%)		Transfusion RBCs
	Hospital-acquired pneumonia	0 (0%)	1 (1%)		Antibiotics
90-day readmissions (n, %)	Total	0 (0%)	2 (3%)	p = 0.409 (x²)p = 1.0 (Fisher's)
90-day readmissions (n, %)	Hospital-acquired pneumonia	0 (0%)	1 (1%)	p = 0.409 (x²)p = 1.0 (Fisher's)	Antibiotics
	Dislocation	0 (0%)	1 (1%)		Revision

DCSA: day case shoulder arthroplasty; RBC: red blood cell.

For categorical outcomes, the effect size metric used was the ORs, which are presented with 95% CIs. Haldane–Anscombe corrections were applied to generate intervals with low cell counts, and intervals for estimating complication and readmission rate bounds were calculated using the Clopper–Pearson exact method. For the linear regression models, simple unstandardised betas are reported with 95% CIs. The threshold for statistical significance was considered p < 0.05 (2-tailed). Thematic analysis was performed on free-text responses regarding the preference for admission in patient questionnaires.

The project is reported in accordance with the STROBE statement for observational studies. The work was approved and registered locally and, therefore, not subject to NHS Research Ethics Committee requirements.

Results

Demographics

Comparison of patient demographics between groups is presented in Table 2. Of the 102 procedures, 25 (25%) were performed as DCSA and 77 (75%) as inpatient admissions. Patients managed as day cases were significantly younger than inpatients (mean age 64.8 vs. 73.6 years; p < 0.001; mean difference = 8.77). Body mass index, sex distribution, indication for surgery and implant type were comparable between groups.

Table 2.

Descriptive statistics for day (n = 25) and inpatient (n = 77) groups.

Variable	Levels	DCSA	Inpatient	Difference
Demographics
Age (mean, SD)	–	64.80 (7.80)	73.57 (7.38)	p < 0.001 (t) MD = 8.77
ASA (n, %)	I	4 (16%)	5 (6%)	p = 0.04 (x²) I OR = 2.74 II OR = 1.72 III OR = 0.09
	II	21 (84%)	58 (75%)
	III	0	14 (18%)
BMI (mean, SD)	–	28.26 (4.43)	29.57 (4.55)	p = 0.24 (t)
Gender (n, %)	Male	10 (40%)	29 (38%)	p = 0.83 (x²)
	Female	15 (60%)	48 (62%)	p = 0.83 (x²)
Side (n, %)	Right	14 (56%)	36 (47%)	p = 0.42 (x²)
	Left	11 (44%)	41 (53%)
Indication (n, %)	Cuff tear arthropathy	5 (20%)	19 (25%)	p = 0.75 (x²)
	Osteoarthritis	20 (80%)	57 (74%)
	Rheumatoid arthritis	0 (0%)	1 (1%)
Type of arthroplasty (n, %)	Total shoulder replacement	15 (60%)	17 (22%)	p = 0.001 (x²) TSR OR = 5.98 RSR OR = 0.32 HA OR = 0.19
	Reverse shoulder replacement	8 (32%)	46 (60%)
	Shoulder hemiarthroplasty	1 (4%)	14 (18%)
Implants (n, %)	Exactech Equinoxe® Platform Shoulder System	20 (80%)	70 (91%)	p = 0.44 (x²)
Implants (n, %)	Exactech Equinoxe® Stemless Shoulder	3 (12%)	4 (5%)
	Arthrex Eclipse™ Total Shoulder System	2 (8%)	3 (4%)

DCSA: day case shoulder arthroplasty; M: mean; SD: standard deviation; MD: mean difference; OR: odds ratio.

DCSA patients were more likely to have lower ASA (OR 2.74 for ASA I), with no cases of ASA III in this group. The type of arthroplasty performed differed significantly between groups (p = 0.001). TSR was more common in the day case cohort (60% vs. 22%; OR = 5.98), while RSR and HA were more common among inpatients (60% and 18% respectively; ORs = 0.32 and 0.19).

Readmission and complication rates

Overall, eight patients experienced a complication within 90 days (7.8%, 95% CI: 3.4%–14.7%), see Table 1. This included one complication in the day case group (4.0%, 95% CI: 0.1%–20.4%) and seven in the inpatient group (9.1%, 95% CI: 3.7%–17.8%).

There were two readmissions in total (2.8%, 95% CI: 0.3%–9.8%), both in the inpatient cohort. The readmission rate within the inpatient group only was 2.6% (2/77; 95% CI: 0.3%–9.1%). Following the day 1 post-operative telephone follow-up, no DCSA patients required additional face-to-face review to check for clinical concerns earlier than planned. There were no deaths in either group.

While the point estimate OR indicated a lower likelihood of complications among day cases, univariable logistic regression showed no significant between-group differences (OR = 0.42, 95% CI = 0.049–3.561; p = 0.42; Akaike information criterion (AIC) = 59.3; R²_McF = 1.4%). This was mirrored in a multivariable logistic regression model adjusted for age, ASA, and procedure type (OR = 0.63, 0.058–6.885; p = 0.71; AIC = 67.1; R²_McF = 5.3%). No significant differences were observed between groups on readmissions using an exact test (OR = 0.417, 95% CI = 0.0487–3.56).

A single case of dislocation resulted in readmission for revision surgery. One patient remained as an inpatient postoperatively due to low haemoglobin, requiring a transfusion of red blood cells and one patient was admitted within a week postoperatively with pneumonia that was treated with antibiotics. All other complications were managed conservatively and had complete resolution of symptoms.

Patient satisfaction

Of the 102 patients, 71 were contactable and agreed to complete the patient questionnaire: 19 were DCSA and 52 had been inpatients. Three patients declined participation, contact details were unavailable for three others, and 25 could not be reached despite repeated attempts. A summary of responses is presented in Table 3.

Table 3.

Count of responses to patient satisfaction telephone questionnaires.

Patient satisfaction questions	Levels	DCSA	Inpatient	Difference	Adjusted models
Preferred admission type (n, %)	Day case	17 (89%)	14 (27%)	p < 0.001 (x²) Day OR = 1.21 Inpat. OR = 0.05	–
Preferred admission type (n, %)	Inpatient	2 (11%)	38 (73%)	p < 0.001 (x²) Day OR = 1.21 Inpat. OR = 0.05	–
Treatment successful? (n, %)	Yes	19 (100)	47 (90%)	p = 0.16 (x²)p = 0.32 (Fisher's)	–
Treatment successful? (n, %)	No	0	5 (10%)	p = 0.16 (x²)p = 0.32 (Fisher's)	–
Recommend treatment? (n, %)	Yes	18 (95%)	39 (75%)	p = 0.06 (x²)p = 0.09 (Fisher's test)	OR 3.34 (95% CI: 0.31–35.97; p = 0.32; AIC = 68.7; McFadden's R² = 22%).
Recommend treatment? (n, %)	No	1 (5%)	13 (25%)	p = 0.06 (x²)p = 0.09 (Fisher's test)	–
Pain day 0 (M, SD)	–	2.47 (2.80)	3.88 (2.76)	p = 0.07 (t)	–
Pain day 1 (M, SD)	–	4 (3.13)	3.48 (2.54)	p = 0.52 (t)	β = 1.44, 95% CI: 0.24–2.64; p = 0.02
Days to pain resolution (M, SD)	–	11.5 (19.25)	19.89 (31.31)	p = 0.20 (t)	β = –9.11 (–26.80 to 8.58); p = 0.31; AIC = 604.1; R² = 12%
Days to uninterrupted sleep (M, SD)	–	5.47 (13.84)	15.72 (20.86)	p = 0.02 (t) MD = 10.25	β = –9.73 (–21.93 to 2.48); p = 0.12; AIC = 584.5; R² = 9%
Days to return to normal activities (M, SD)	–	49.74 (44.18)	45.43 (34.96)	p = 0.71 (t)	β = 1.73 (–22.38 to 25.83); p = 0.66; AIC = 715.8; R² = 1%
Days to return to driving (M, SD)	–	46.05 (21.3)	54.72 (40.49)	p = 0.29 (t)	β = –0.43 (–22.82 to 21.96); p = 0.85; AIC = 581.9; R² = 12%

DCSA: day case shoulder arthroplasty; M: mean, SD: standard deviation, MD: mean difference; OR: odds ratio; AIC: Akaike information criterion.

Perceived success of treatment was reported by 100% of DCSA patients and 90% of inpatients (p = 0.16; Fisher's p = 0.32). Recommendation rates were also high in both groups: 95% of DCSA patients would recommend their treatment to others, compared with 75% of inpatients (p = 0.06; Fisher's p = 0.09). The odds of recommending treatment were six times higher in the DCSA group (OR = 6.0).

The preference for admission type differed significantly. Among DCSA patients, 89% stated they would prefer the same pathway again, whereas only 27% of inpatients said they would have preferred DCSA if offered (p < 0.001). The odds of preferring DCSA were substantially higher among those who experienced it (OR ≈ 23.1).

In both cohorts, reasons given for preferring DCSA included having supportive family or friends with whom they could stay and preferring to be in home surroundings. Inpatients who preferred to be on this pathway cited living alone or with dependants, having comorbidities, previous problems with anaesthesia, needing overnight observation for safety, pain control and living a significant distance from the hospital as reasons for their preference. Of the two DCSA patients who would have preferred to have been inpatients, both listed the inability of their partners to care for them as a reason.

While most self-reported outcomes showed no statistically significant differences between groups, patients who underwent DCSA reported a significantly quicker return to uninterrupted sleep and were far more likely to prefer the day case pathway. Multivariable analysis revealed significantly higher day 1 pain in the DCSA group, despite comparable unadjusted pain scores. However, the difference of 1.44 on a 10-point scale measure was deemed of minor clinical significance.

Cost analysis

In the year 2022/2023, the estimated cost per hospital bed day for rehabilitation for joint replacement was quoted as £410.51.⁵ In the single elective hospital in this study, over a three-year period, 25 patients underwent DCSA that would historically have been performed as inpatients at our centre. This equates to an estimated cost saving for these DCSA patients of £10,262.75 for 25 hospital bed days saved. In this inpatient cohort, the total sum of hospital bed days was 92. If these patients had been on the DCSA pathway, there would be an additional cost saving of £37,766.92.

Discussion

The authors believe this study contributes to the limited literature on DCSA outcomes, especially in the UK. A recent systematic review and meta-analysis identified only eight studies worldwide comparing outcomes of DCSA with inpatient shoulder arthroplasty.⁶ Moreover, only three small studies have been conducted reviewing DCSA within the UK, and only two of these compared day case and inpatient cohorts.^4,10,11 No previous studies have compared the outcomes of all three main types of shoulder arthroplasty across both day case and inpatient cohorts.

Patient safety

Our results confirm DCSA is safe, with a very low 90-day complication rate of 4% in the DCSA cohort (n = 1) compared to 9% in the inpatient cohort (n = 7). There were no cases of 90-day readmissions in the DCSA cohort and two cases (2%) in the inpatient cohort. There was no statistical difference in primary outcomes between the DCSA and the inpatient group. Lower rates of complications and readmission rates in the DCSA could be explained by the fewer comorbidities in this cohort and careful patient selection generated by the DCSA pathway. Reassuringly, there were no cases of mortality in either group. These findings are supported by other studies by Basques et al.,¹² which is the largest study worldwide to date. This analysis of the Medicare dataset found higher rates of 90-day complications and readmissions in the inpatient cohort (12.1% and 2.9%, respectively). The authors reported that inpatients were more likely to be women, smokers, and have more comorbidities. Similar findings have been confirmed elsewhere in the literature.^6,7,13,14

Our study found significantly more patients underwent TSR in the DCSA compared to the inpatient group. This could be explained by the lower ASA and mean age in this cohort, as these patients were more likely to be of working age with higher functional demand and a functioning rotator cuff, making them suitable candidates for TSR.

The majority of previous studies reporting on DCSA have focused on TSR and HA, with only 15% reporting on outcomes of RSR⁷. RSR is currently the most commonly performed shoulder replacement in the UK, and was the most commonly performed arthroplasty in our series, with 54% of cases being RSR (n = 55).^15,16 Antonacci et al.¹⁷ reviewed 52 RSRs performed as day cases compared to 92 performed as inpatients in the US. Their population had similar demographics to ours and had comparable 90-day complications (7.7%) and readmission rates (1.9%) between their groups. This higher complication rate in their DCSA cohort compared to our study could be explained by the inclusion of revision arthroplasty in their study. However, they also found no significant differences in 90-day readmission and complication rates between groups.

Elgalli et al.¹¹ evaluated the safety of delivery of DCSA in a dedicated stand-alone day case unit in the UK. This series included HA initially and later TSR over a five-year period. The complication rate was 20%, and 5% overall mortality and revision rate. Readmission was not assessed in their study, but they found similar results of no significant difference in outcomes between DCSA and inpatient cohorts. Two smaller studies reported similar outcomes of no complications or readmissions at either 30 or 90 days.^10,18 Our findings support the conclusions that DCSA is safe, with a similar complication and readmission risk to inpatient surgery.

Patient satisfaction

Our study has reported high rates of patient satisfaction with DCSA, with 100% of patients feeling their treatment had been successful and 94.7% recommending the day case pathway. This is similar to high satisfaction rates reported by Leroux et al.¹⁹ at 97% and by Nelson et al.¹³ In addition, 27% of those who were inpatients would have preferred to have been day cases, if this had been offered to them. These findings align with other studies that have reported that both patients and clinicians prefer day case arthroplasty.^11,20,21

Pain reported on day 0 and day 1 postoperatively was reassuringly well controlled, with mean scores ranging from 2.5 to 4 across all groups. Day 1 post-operative pain was slightly higher in the DCSA group by 1.4 on the 10-point scale measure. It was hypothesised that the inpatient group may have received additional analgesia or that the DCSA group may report pain differently outside of the hospital environment. Whilst this differs from other studies, this was felt to be of minor clinical significance, and the authors do not feel this affected the overall patient satisfaction. The findings have been discussed with anaesthetic colleagues, who recommended that no changes to the protocol were required. No patients were readmitted for pain control. This should reassure clinicians that regional nerve blocks are effective and that inpatient stays should not be routinely planned to anticipate the need for pain control postoperatively.

DCSA patients returned to uninterrupted sleep more quickly than their inpatient counterparts. It is well established that patients struggle to sleep whilst in hospital, and an increasing number of comorbidities contribute to poorer sleep.^22,23 Time to pain resolution and return to driving was shorter in DCSA patients, but this was not found to be statistically significant. The DCSA group took slightly longer to return to normal activities, which may be due to the lower mean age, higher proportion of TSRs performed and higher likelihood of being of working age necessitating the need to get back to a higher level of function.

Cost savings

Gregory et al.²⁴ reported that DCSA is three times cheaper than inpatient surgery. An estimated £129,721.66 was spent by NHS England on rehabilitation beds for joint replacements in 2022/2023 alone. In the year 2022/2023, the estimated cost per hospital bed day for rehabilitation for joint replacement was quoted as £410.51.⁵ In this study, the estimated cost savings for hospital bed days saved were £10,262.75 over three years, but this could have totalled £48,029.67 if all patients in the study had been day cases. These cost savings are an underestimate as additional costs such as blood tests, electrocardiograms, and additional therapist visits, etc., have not been accounted for. Day case surgery can proceed without the reliance on a bed space postoperatively, which is often difficult to obtain in the current climate of the NHS, particularly during winter pressures.²⁵ This will help tackle the current waiting list of 800,000 patients waiting for elective orthopaedic surgery.³

Limitations

We acknowledge that patients undergoing DCSA were generally healthier and younger than those who did not have DCSA. As such, these differences may influence the outcomes and likely bias in favour of DCSA. We performed multivariate logistic regression adjusting for age, ASA and implant type; however, residual confounding remains due to small sample size. Given the small sample size, we recognise the study is also likely to be underpowered and therefore results should be interpreted as preliminary indicators of feasibility and safety as opposed to conclusive comparative outcome data. Additionally, the telephone questionnaire was locally designed and not validated, introducing the risk of recall and response bias. Finally, the precise number of patients initially planned for DCSA that subsequently required inpatient admission was not consistently recorded in the departmental database. These figures have therefore not been reported, but anecdotally, were low.

Despite the limitations, we believe this is the most comprehensive study in the UK comparing both DCSA and inpatient cohorts, assessing 90-day readmission and complication rates, as well as patient satisfaction and cost savings. An element of recall bias is inevitable in the patient satisfaction questionnaire results, particularly in the evaluation of post-operative pain. However, Lowe et al.²⁶ found that patients overestimated their pain immediately postoperatively when asked to recall their pain scores more than six months after their operation. Therefore, the relatively low pain scores reported in our study are probably overestimated. In addition, cost analyses are likely to have underestimated the cost savings with DCSA, as we were unable to account for additional costs that may have taken place in the inpatient cohort.

Conclusion

DCSA is a safe procedure in appropriately selected patients with minimal complications and readmission rates. It reduces inpatient bed utilisation and is associated with high patient satisfaction. DCSA could be more widely adopted across the UK, with the potential for significant cost savings and improved waiting list times. Furthermore, the original DCSA pathway could be reviewed, and its indications expanded to potentially include a larger cohort of patients whilst maintaining patient safety.

Supplemental Material

sj-docx-1-sel-10.1177_17585732261425939 - Supplemental material for Outcomes of a UK day case shoulder arthroplasty pathway: Safety, patient satisfaction and cost-saving analysis

Supplemental material, sj-docx-1-sel-10.1177_17585732261425939 for Outcomes of a UK day case shoulder arthroplasty pathway: Safety, patient satisfaction and cost-saving analysis by Sophie J Donoghue, James Allen, Luke Budworth, Andrew Murphy, Mark Brinsden and Paul Guyver in Shoulder & Elbow

Footnotes

Acknowledgements

None.

ORCID iD

Sophie J Donoghue

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical committee approval

UHP: CA_2024-25-348.

Supplemental material

Supplemental material for this article is available online.

References

Padegimas

Maltenfort

Lazarus

, et al. Future patient demand for shoulder arthroplasty by younger patients: national projections. Clin Orthop Relat Res 2015; 473: 1860–1867.

Valsamis

Collins

Pinedo-Villanueva

, et al. Association between surgeon volume and patient outcomes after elective shoulder replacement surgery using data from the national joint registry and hospital episode statistics for England: population based cohort study. Br Med J 2023; 381: e075355.

Improvement NEa. Statistical press notice: NHS referral to treatment (RTT) waiting times data, December 2023. 2024.

Allahabadi

Cheung

Hodax

, et al. Outpatient shoulder arthroplasty – a systematic review. J Shoulder Elb Arthroplast 2021; 5: 24715492211028025.

Dey

Gadde

Sobti

, et al. The safety and efficacy of day-case total joint arthroplasty. Ann R Coll Surg Engl 2021; 103: 638–644.

Malahias

M-A

Kokkineli

, et al. Day case versus inpatient total shoulder arthroplasty: a systematic review and meta-analysis. Shoulder Elbow 2021; 13: 471–481.

Allen

Abdelmonem

Fieraru

, et al. Introducing a day-case shoulder arthroplasty pathway in the UK–how we did it. Shoulder Elbow 2023; 15: 311–320.

2022/23 National cost collection data publication. 2024. NHS England.

RCoreTeam. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing, 2025.

10.

Tansey

Almustafa

Hammerbeck

, et al. Reverse shoulder replacement: a day-case procedure. JSES Int 2020; 4: 397–399.

11.

Elgalli

Hind

Lahart

, et al. Outcomes of day case shoulder replacement surgery in a stand-alone day care unit in the United Kingdom. Shoulder Elbow 2023; 15: 300–310.

12.

Basques

Erickson

Leroux

, et al. Comparative outcomes of outpatient and inpatient total shoulder arthroplasty. Bone Joint J 2017; 99-B: 934–938.

13.

Nelson

Murphy

Mulligan

, et al. A retrospective comparative study of patient satisfaction following ambulatory outpatient and inpatient total shoulder arthroplasty. Curr Orthop Pract 2019; 30: 435–438.

14.

Ling

Smolev

Tantone

, et al. Smoking is an independent risk factor for complications in outpatient total shoulder arthroplasty. JSES Int 2023; 7: 2461–2466.

15.

Craig

Goodier

Singh

, et al. Shoulder replacement surgery for osteoarthritis and rotator cuff tear arthropathy. Cochrane Database Sys Rev 2020; 4: CD012879.

16.

Evans

Craig

, et al. How long does a shoulder replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 10 years of follow-up. Lancet Rheumatol 2020; 2: e539–e548.

17.

Antonacci

Vazquez

Alberta

. Complications and readmissions following reverse total shoulder arthroplasty with same-day discharge. Semin Arthroplasty: JSES 2020; 30: 242–249.

18.

Borakati

Ali

Nagaraj

, et al. Day case vs inpatient total shoulder arthroplasty: a retrospective cohort study and cost-effectiveness analysis. World J Orthop 2020; 11: 213–221.

19.

Leroux

Zuke

Saltzman

, et al. Safety and patient satisfaction of outpatient shoulder arthroplasty. JSES Open Access 2018; 2: 13–17.

20.

Crawford

Sprague

, et al. Clinical and cost implications of inpatient versus outpatient orthopedic surgeries: a systematic review of the published literature. Orthop Rev (Pavia) 2015; 7: 6177.

21.

Kelly

Calkins

Culvern

, et al.

Inpatient versus outpatient hip and knee arthroplasty: which has higher patient satisfaction?

J Arthroplasty 2018; 33: 3402–3406.

22.

Swann

Batty

, et al. Sleep disturbance in orthopaedic trauma patients. J Orthop Trauma 2018; 32: 500–504.

23.

Hayashino

Yamazaki

Takegami

, et al. Association between number of comorbid conditions, depression, and sleep quality using the Pittsburgh Sleep Quality Index: results from a population-based survey. Sleep Med 2010; 11: 366–371.

24.

Gregory

Wetzig

Wayne

, et al. Quantification of patient-level costs in outpatient total shoulder arthroplasty. J Shoulder Elbow Surg 2019; 28: 1066–1073.

25.

Herrod

Adiamah

Boyd-Carson

, et al. Winter cancellations of elective surgical procedures in the UK: a questionnaire survey of patients on the economic and psychological impact. BMJ Open 2019; 9: e028753.

26.

Lowe

Fasulo

, et al. Patients recall worse preoperative pain after shoulder arthroplasty than originally reported: a study of recall accuracy using the American Shoulder and Elbow Surgeons score. J Shoulder Elbow Surg 2017; 26: 506–511.

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