Simplified Selection Algorithm for Outpatient Shoulder Arthroplasty: The ECBE Method

Outpatient shoulder arthroplasty is increasing in popularity due to advancements in surgical techniques as well as intra-operative and perioperative pain management. However, complex patient selection tools and risk models limit widespread adoption. This study introduces and evaluates the Exclusion Criteria Based Eligibility (ECBE) method for selecting patients suitable for outpatient shoulder arthroplasty. A retrospective analysis was conducted on a prospectively maintained cohort of all 149 patients who underwent primary shoulder arthroplasty by a single surgeon between January 2021 and September 2024. Patients were prospectively evaluated using the ECBE method, which excludes only those living alone, requiring an assistive devise for ambulation, or with serious unstable medical conditions. Those deemed eligible were prepared for same-day discharge. Outcome measures included successful same-day discharge rate, postoperative complications, emergency department visits, and 90-day readmissions. Of 149 patients, 107 (72%) met ECBE criteria and were scheduled for outpatient surgery. Among these, 101 patients (94%) were successfully discharged on the same day. The six patients (6%) requiring admission did so for unpredictable medical or logistical reasons, none related to surgical complications nor inadequate pain management. Within the outpatient cohort, there were no emergency department (ED) visits within 7 days postoperatively; one patient (0.9%) was admitted within 90 days for an unrelated medical issue, and one patient had a surgical complication (0.9%), a dislocation at 2 months post-op treated by closed reduction in the ED. The ECBE method is a safe, effective, and practical tool for identifying candidates for outpatient shoulder arthroplasty. With just three exclusion criteria, it achieves high accuracy in predicting successful same-day discharge while minimizing unnecessary inpatient admissions. The simplicity of this approach supports its broad clinical applicability and has the potential to streamline outpatient selection in shoulder arthroplasty.