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The Safety of Outpatient Shoulder Surgery at a Freestanding Ambulatory Surgery Center in Patients 65 years old and older: a review of 640 cases
Aleksandra Krajewski, Kristin Buterbaugh, Stephen Liu, Glenn Buterbaugh, Joseph Imbrigli
University of Pittsburgh
2017-02-15
Presenter: Aleksandra Krajewski
Affidavit:
Aleksandra Krajewski
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Introduction: Over the past two decades there has been a significant shift from inpatient to outpatient surgery for rotator cuff repair – the most common performed outpatient shoulder surgery. In general, there is a paucity of patient safety data from ambulatory surgery centers. We hypothesize that a low rate of adverse events can be achieved with a select patient population
Methods: A retrospective review of shoulder cases in patients age 65 and older performed by two board-certified hand and upper extremity surgeons at a single freestanding ambulatory surgery center over a seventeen-year period (2000-2016) was performed. The procedures included CPT codes for subacromial decompression, distal clavicle excision, biceps tenodesis, rotator cuff repair (open and arthroscopic), tuberoplasty, and shoulder arthroscopy. Using state-reportable adverse events criteria as a guideline, we divided these into seven main categories: acute infection (defined as requiring formal irrigation and debridement in the operating room or inpatient admission for intravenous antibiotics), postoperative transfer to a hospital, wrong-site surgical procedure, retention of a foreign object, postoperative symptomatic thromboembolism, medication error, and bleeding complications.
Results: All of the 640 procedures that were performed were included in our analysis. Rate of complications based on state-reportable categories was 1.25% (8/640). These included 3 infections requiring iv antibiotics or readmission, 1 bleeding requiring aspiration, and 4 postop transfer to hospital.
Discussion: Our adverse event rate consistent with existing data. The results also show a number of independent risk factors for adverse event occurrence including age 80 or older, BMI >35, and functional dependent status.
