Ambulatory Reverse Shoulder Arthroplasty in a Medium-Complexity Orthopedic Center: Early Outcomes of a Structured Multidisciplinary Clinical Pathway

Abstract

Background
Reverse shoulder arthroplasty (RSA) has traditionally been performed with inpatient postoperative observation because of concerns regarding perioperative complications, postoperative pain control, and early functional recovery. However, improvements in perioperative management and patient selection have enabled the expansion of shoulder arthroplasty into ambulatory settings. Although several studies have reported favorable outcomes following outpatient shoulder arthroplasty, less attention has been given to the specific clinical pathways that support safe implementation of ambulatory RSA.
Purpose
To evaluate the early clinical outcomes of patients undergoing ambulatory reverse shoulder arthroplasty within a structured multidisciplinary clinical pathway emphasizing careful patient selection, opioid-sparing multimodal anesthesia, early supervised rehabilitation, and close postoperative follow-up.
Methods
A prospective observational cohort study was conducted including consecutive patients who underwent ambulatory RSA performed by two shoulder surgeons between February 2024 and December 2025 at a specialized orthopedic center. Patient eligibility followed strict clinical and social selection criteria designed to ensure safe same-day discharge. Perioperative management incorporated multimodal regional anesthesia and opioid-sparing analgesia protocols. Postoperative recovery included early supervised home-based physiotherapy and proactive monitoring through nurse visits, telephone follow-up, and scheduled clinical assessments. Outcomes evaluated included postoperative complications, pain trajectories measured using the Visual Analog Scale (VAS), and functional recovery assessed with the American Shoulder and Elbow Surgeons (ASES) score during a 90-day follow-up period.
Results
Thirty-four patients, mostly females (64.3%), underwent ambulatory RSA. The mean age was 70.9 +- 11.2 years. Surgical indications included glenohumeral arthrosis, massive rotator cuff tear, and chronic shoulder dislocation. All patients were classified as ASA II. Regional anesthesia consisted of an interscalene block or a brachial plexus block. Postoperative analgesia was managed with an elastomeric infusion pump or a transdermal buprenorphine patch. ll procedures were successfully completed with same-day discharge following the institutional ambulatory arthroplasty protocol. At the final follow-up, pain and functional outcomes improved significantly compared with preoperative values (p = 0.004 and 0.019, respectively). No complications, readmissions, reoperations, or infections occurred during the 90-day follow-up period.
Conclusions
Ambulatory reverse shoulder arthroplasty can be performed safely in carefully selected patients when supported by a structured multidisciplinary clinical pathway that includes multimodal opioid-sparing anesthesia, early supervised rehabilitation, and proactive postoperative monitoring. This approach resulted in excellent pain control and marked early functional improvement without complications in this cohort.