New Study Concludes Outpatient Shoulder Replacement Reduces Costs, Delivers Similar Patient Outcomes

Outpatient total shoulder arthroplasty (TSA) provides comparable patient outcomes to inpatient procedures with a significant cost reduction, according to a new study published in the Journal of Shoulder and Elbow Arthroplasty.

"This study demonstrates that outpatient shoulder replacement can provide excellent value for both patients and the healthcare system," said Hafiz F. Kassam, MD, senior author of the study and director of shoulder reconstruction at Hoag Orthopedic Institute (HOI). Dr. Kassam is also among the highest-volume shoulder surgeons on the West Coast.

The study was the first of its kind to use a Markov decision-analytic model to evaluate long-term costs, complications, revision surgeries, readmissions and patient quality of life over a 20-year horizon. Both anatomic and reverse total shoulder arthroplasty performed in outpatient and inpatient settings were analyzed.

Outpatient surgery patients experienced similar long-term health outcomes, and the outpatient approach remained cost-effective in 89 percent of simulations. Outpatient TSAs cost an average of $23,375, compared with $28,402 for inpatient TSAs. The difference was driven primarily by lower facility costs rather than differences in surgical complications.

The findings suggest outpatient shoulder replacement may help healthcare systems and insurers advance value-based care goals in carefully selected patients. The study emphasizes proper patient selection, noting that inpatient care may remain more appropriate for higher-risk surgical candidates and economic drivers should not override surgeon judgement on site of care.

"Our study concluded that for straightforward, primary shoulder arthroplasty, the outpatient setting offers a strong economic advantage while maintaining similar long-term patient outcomes compared with inpatient surgery," said Dr. Kassam.