THE FRAMEWORK FOR INTRODUCING AN ELECTIVE DAY-CASE SHOULDER ARTHROPLASTY PATHWAY IN A PUBLIC HEALTH SERVICE

Day case arthroplasty is safe, cost-effective option for appropriately selected patients, and is increasingly used in shoulder replacement surgery. In response to inpatient bed pressures and extended waiting lists following the COVID-19 pandemic, a multidisciplinary day case shoulder arthroplasty pathway was developed at our centre. This study assessed its safety by comparing readmission, reoperation and complication rates between day case(DC) and inpatient(IP) groups. Secondary aims included patient satisfaction, perceived safety and Oxford Shoulder Scores(OSS). A retrospective review of consecutive elective shoulder arthroplasties over two years at a single centre was performed. Patients were grouped as DC or IP. Demographic, perioperative and post-operative outcome data were collected. A standardised questionnaire was distributed at a minimum of three months post-operatively. Statistical analysis compared outcomes between groups. Forty-six patients underwent elective shoulder arthroplasty; 28 (61%) were successfully managed as day cases. Nine (20%) pre-selected DC candidates pre-operatively required an overnight admission. There was one readmission(2.2%) in the DC cohort within 3 days of discharge due to a minor wound issue. No reoperations, infections, venous thromboembolisms or mortalities occurred. Patient satisfaction was high in both groups, with all patients reporting confidence in postoperative support. Mean OSS were higher in the DC group(43.9 vs 38.6, p=0.018), with similar mean improvement from baseline(+27.7, p = 0.35). Day case shoulder arthroplasty can be safely and effectively delivered within a UK public health service. This pathway, supported by clear exclusion criteria and structured counselling, enables broader patient selection with excellent satisfactions and perceived safety.