Charles Fryberger, MD1 Thomas W. Throckmorton, MD1 SaeRam Oh, BS2 Jim Wan, PhD3 Frederick M. Azar, MD1 Tyler J. Brolin, MD1 1
University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering Memphis, Tennessee
2
University of Tennessee Health Science Center College of Medicine Memphis, Tennessee
3
University of Tennessee Health Science Center Department of Biostatistics and Epidemiology Research Department Memphis, Tennessee
Single Dose Antibiotic Regimens in Total Shoulder Arthroplasty are Safe in the Outpatient Surgery Setting Background As the healthcare environment continues to evolve, government and regulatory organizations continue to place increasing emphasis on the delivery of safe, high-quality, cost-effective, and efficient healthcare. This has led to a shift toward shorter hospital stays and increased utilization of the outpatient setting for total joint arthroplasty. Shoulder arthroplasty is a valuable procedure in the treatment of end-stage shoulder condition, and the demand for total shoulder arthroplasty (TSA) continues to increase. Recent literature supports outpatient shoulder arthroplasty as a safe alternative to the traditional inpatient setting in appropriately selected patients. One potential drawback to outpatient TSA is the inability to administer 24 hours of intravenous (IV) prophylactic antibiotics to prevent prosthetic joint injection (PJI) as generally, patients are sent home on the same day of surgery.
Methods An institutional database query was used to identify patients who underwent either primary anatomic (aTSA) or reverse total shoulder arthroplasty (rTSA) between the years of 2009 to 2019. Patient candidacy for outpatient TSA was based on each patient’s overall health status, adequacy of social support, and patient preference. A multidisciplinary team comprised of physical therapy, anesthesiology and orthopaedic surgery evaluated the patient preoperatively for candidacy of outpatient TSA. Of the total 1,022 patients identified, 896 received 24hr of perioperative IV antibiotics while in the traditional inpatient setting and 126 patients received a single dose of preoperative IV antibiotics (single) prior to undergoing an outpatient TSA at an ambulatory surgery center. Outcomes measured include overall infection and revision rates. Infection rate was further subcategorized into superficial versus deep infection. Additionally, the timing of infection was subcategorized as early, with the diagnosis made within first three months after the procedure, or late, with the diagnosis made after three months.
Results
Corresponding Author Tyler J. Brolin, MD 1458 W. Poplar Avenue, Suite 100 Collierville, TN 38017 P: 901-759-5522 F: 901-759-3195 tbrolin@campbellclinic.com
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The 896 patients who received 24hr of IV antibiotics had an average age of 67.6±9.9 years (age range of 22-90). The average age of the 129 patients who received a single dose of antibiotics was 57.3±7.7 years (range of 33 to 79). The 24hr groups was on average 10.3 years older (p<0.001) than the single dose cohort. The patients in the 24hr group were more likely to undergo rTSA (61.5% vs 29.4%; p=<0.0001), more likely to have diabetes (23.0% vs 10.3%; p=0.001), and hypertension (69.3% vs 47.6%, p=<0.0001). The patients in the single dose group were more likely to have undergone previous non-arthroplasty shoulder surgery on the operative side (23.8% vs 16.5%; p=0.04). Employment status (p=<0.0001) and indication for procedure (p=0.001) varied significantly between the two groups. The patients in single dose group were more likely to be employed and patients in the 24hr group were more likely to be retired (employed single: 73.8% vs 24hr: 24.4%, retired single: 14.3% vs 24hr: 57.1%, unemployed single: 11.9% vs 24hr: 18.5%).
CAMPBELL ORTHOPAEDIC JOURNAL • VOLUME 7, 2021
