DAY-CASE OPEN SHOULDER SURGERY– A PROSPECTIVE STUDY OF A PERI-OPERATIVE PROTOCOL

Abstract

OBJECTIVE: To evaluate a peri-operative protocol developed to facilitate day case open shoulder procedures that historically have required overnight hospital admission.

METHODS: 75 consecutive day-case open shoulder procedures were performed in 75 patients (aged 18 – 65) followed up prospectively for a minimum of 6 months. The procedures included Open Primary Anterior Capsulo-Labral Reconstruction (ACLR) (24), open Revision ACLR (4), open Posterior Capsulo-Labral Reconstruction (1), mini-arthrotomy and rotator cuff repair (6), mini-arthrotomy and subacromial decompression (27), modified Weaver Dunn Reconstruction of Acromio-clavicular joint (ACJ) (2), decompression of ACJ (7), open release (Ozaki procedure) for frozen shoulder (1). Exclusion criteria included concomitant medical problems, and patients who would have no assistance in their care for the first 24 post operative hours. All patients received fast track general anaesthesia, peri-operative analgesia using intravenous Fentanyl, and Diclofenac (PR), and local Bupivicaine 0.5% to incisions and intra-articular spaces; patients were discharged with oral analgesics.

MAIN OUTCOME MEASURES: Patient satisfaction with overall experience, pain control, the incidence of nausea that was difficult to manage, the incidence of unplanned admission, attendance or delayed admission to hospital, postoperative complications.

RESULTS: 98% of patients were satisfied with their pain management. None of the patients suffered intractable post operative pain nausea or vomiting or required unplanned hospital admission or unexpected re-admission. All the patients were satisfied with their experience. There were no short or long term post operative complications.

CONCLUSION: The anaesthetic protocol and surgical techniques used in this study permitted same day discharge for a wide variety of open shoulder procedures. For selected patients, open shoulder surgery as a day case appears safe effective and acceptable to the patient.