Quick answer: For many patients, yes. Shoulder replacement is increasingly performed as same-day (outpatient) surgery, and in Medicare patients the share of shoulder replacements discharged the same day rose to about 36% by late 2022 [1]. In carefully selected patients, studies have found no increase in complications, readmissions, or revision compared with an overnight stay [2, 3]. The key is patient selection: your overall health, lung and heart conditions, and support at home all matter [4, 5].
How Common Is Outpatient Shoulder Replacement?
Starting January 1, 2021, Medicare removed total shoulder replacement from its "inpatient-only" list, allowing it to be performed as an outpatient procedure for Medicare patients [3]. Since then, outpatient shoulder replacement has grown rapidly. In Medicare claims, 36% of shoulder replacements were discharged the same day by the end of 2022, a higher proportion than for hip or knee replacement [1]. The AAOS notes that shoulder replacements are among the joint replacements that can be done on an outpatient basis [5].
Is It Safe?
The evidence is reassuring for appropriately selected patients:
- A meta-analysis of nearly 200,000 shoulder replacements found no difference in 30- or 90-day readmissions between outpatient and inpatient surgery, and no difference in complications in studies that used matched comparison groups. Revision rates were similar at one to two years [2].
- A national database study that matched outpatients to inpatients with similar health risks found no differences in adverse events or readmissions [3].
- In Medicare patients, who often have more health conditions than privately insured patients, a short hospital stay did not increase 90-day readmissions [6].
One caveat: outpatients in these studies were, on average, younger and healthier [2, 3]. The safety record reflects careful patient selection, not that everyone should go home the same day.
Who Is a Good Candidate?
Factors that generally favor outpatient surgery [4, 5]:
- Good overall health and functional independence
- Well-controlled medical conditions
- A reliable adult who can stay with you for the first few days
- Transportation to follow-up visits and therapy
Factors that may make an overnight stay safer [4, 5]:
- Significant heart disease, such as heart failure
- Chronic obstructive pulmonary disease (COPD) or other significant lung disease
- Kidney failure or dialysis
- Poorly controlled diabetes, a higher body mass index, or long-term opioid use
- Limited support at home
Why Lung Health Matters for Shoulder Surgery
Most shoulder replacements use an interscalene nerve block, an injection near the neck that numbs the shoulder for many hours. Because the nerve to the diaphragm runs nearby, these blocks commonly cause temporary weakness of the diaphragm on that side. In a classic study, this occurred in every patient tested, resolving within a few hours of the injection [7]. Healthy patients rarely notice, but in people with significant lung disease, this can matter, which is one reason lung health is part of the outpatient decision.
What Does Same-Day Surgery Look Like?
- Before surgery: Medical clearance, anesthesia planning, and education about pain control and sling use.
- Surgery day: The procedure, typically with a nerve block and general anesthesia, followed by several hours in recovery while you're monitored, eat, and walk.
- Going home: You leave with your arm in a sling, a pain-control plan that aims to minimize opioids, and instructions for wound care and exercises [8].
- First days at home: A caregiver helps with dressing, meals, and getting to appointments.
How to Prepare
- Set up your home so everyday items are at waist height, since reaching up will be hard for several weeks [8].
- Arrange a caregiver for at least the first few days.
- Plan transportation, since you won't drive for several weeks [8].
- Ask your surgeon who to call after hours if you have concerns.
Frequently Asked Questions
Is outpatient surgery less expensive?
Studies have generally found that outpatient shoulder replacement costs less than inpatient surgery [2, 4]. Your out-of-pocket cost depends on your insurance.
Will I have more pain at home?
Pain control is planned in advance, typically combining a long-acting nerve block, anti-inflammatory medications, and ice, with opioids used sparingly [8]. Many patients find recovering at home more comfortable.
What if I'm not a candidate for same-day surgery?
A one-night stay is still very common and is the safer choice for some patients. Most admitted patients go home the next day [8].
Related Reading
Dr. Tej Joshi performs shoulder replacement surgery and sees patients at NYU Langone offices in Manhattan, Lake Success, and Bay Ridge, Brooklyn.
References
- Fedorka CJ, Srikumaran U, Abboud JA, et al. Trends in the adoption of outpatient joint arthroplasties and patient risk: a retrospective analysis of 2019 to 2021 Medicare claims data. J Am Acad Orthop Surg. 2024;32(15):e741-e749. PubMed 38452268 · doi:10.5435/JAAOS-D-23-00572
- Ahmed AF, Hantouly A, Toubasi A, et al. The safety of outpatient total shoulder arthroplasty: a systematic review and meta-analysis. Int Orthop. 2021;45(3):697-710. PubMed 33486581 · doi:10.1007/s00264-021-04940-7
- Trudeau MT, Peters JJ, LeVasseur MR, et al. Inpatient versus outpatient shoulder arthroplasty outcomes: a propensity score matched risk-adjusted analysis demonstrates the safety of outpatient shoulder arthroplasty. J ISAKOS. 2022;7(2):51-55. PubMed 35546436 · doi:10.1016/j.jisako.2022.01.001
- Vajapey SP, Contreras ES, Neviaser AS, Bishop JY, Cvetanovich GL. Outpatient total shoulder arthroplasty: a systematic review evaluating outcomes and cost-effectiveness. JBJS Rev. 2021;9(5). PubMed 33956691 · doi:10.2106/JBJS.RVW.20.00189
- American Academy of Orthopaedic Surgeons. Outpatient Total Joint Replacement. OrthoInfo. orthoinfo.org
- Goltz DE, Burnett RA, Wickman JR, et al. Short stay after shoulder arthroplasty does not increase 90-day readmissions in Medicare patients compared with privately insured patients. J Shoulder Elbow Surg. 2022;31(1):35-42. PubMed 34118422 · doi:10.1016/j.jse.2021.05.013
- Urmey WF, Talts KH, Sharrock NE. One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography. Anesth Analg. 1991;72(4):498-503. PubMed 2006740 · doi:10.1213/00000539-199104000-00014
- American Academy of Orthopaedic Surgeons. Shoulder Joint Replacement. OrthoInfo. orthoinfo.org