Impact of enhanced recovery after surgery protocols on patient-reported outcomes and satisfaction following shoulder arthroplasty: a systematic review
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Background
As shoulder arthroplasty volume rises globally, evidence on optimal perioperative rehabilitation and analgesia remains limited. This systematic review evaluated enhanced recovery after surgery postoperative strategies on patient-reported outcomes and satisfaction.
Methods
PubMed, Embase, MEDLINE, Global Health, and Cochrane Library were searched per Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. Studies undergoing total shoulder arthroplasty or reverse total shoulder arthroplasty (RTSA) were included. Interventions: rehabilitation timing and analgesic protocols. Outcomes: American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), Single Assessment Numeric Evaluation (SANE), range of motion, Quality of Recovery-15, and satisfaction.
Results
Eighteen studies including 1,722 patients (total shoulder arthroplasty: n = 7; RTSA: n = 2; mixed: n = 9) were analyzed. Delayed rehabilitation after RTSA improved early pain scores (ASES pain 26.3 ± 16.3 vs. 16.7 ± 11.6 at 6 months; P = .01) and overall function (ASES total 40.2 ± 20.1 vs. 30.0 ± 18.8; P = .04), without affecting long-term outcomes (ASES 88-90, SST 9.8-9.9, SANE 85-88 at 12 months). Opioid-sparing and opioid-free protocols achieved equivalent functional recovery (ASES 74-89, SST 6-9, SANE 24-28 change-from-baseline) and consistently higher patient satisfaction (86-97%) at 2-6 weeks. Continuous interscalene blocks and liposomal bupivacaine provided effective analgesia (Quality of Recovery-15 postoperative day 3: 124.5-132.0), with trends toward improved early recovery. Across studies, range of motion outcomes (forward flexion 126-146° and external rotation 57-62°) were comparable, indicating multiple enhanced recovery after surgery strategies can deliver similar functional and patient-reported outcomes while enhancing early recovery and satisfaction.
Conclusion
Functional recovery following shoulder arthroplasty appeared robust across diverse rehabilitation and analgesic strategies. Delayed rehabilitation offered early pain advantages, and opioid-sparing approaches enhanced patient satisfaction without compromising outcomes. These findings supported a personalized, patient-centered approach to postoperative care and highlight the need for further high-quality comparative trials.
As shoulder arthroplasty volume rises globally, evidence on optimal perioperative rehabilitation and analgesia remains limited. This systematic review evaluated enhanced recovery after surgery postoperative strategies on patient-reported outcomes and satisfaction.
Methods
PubMed, Embase, MEDLINE, Global Health, and Cochrane Library were searched per Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. Studies undergoing total shoulder arthroplasty or reverse total shoulder arthroplasty (RTSA) were included. Interventions: rehabilitation timing and analgesic protocols. Outcomes: American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), Single Assessment Numeric Evaluation (SANE), range of motion, Quality of Recovery-15, and satisfaction.
Results
Eighteen studies including 1,722 patients (total shoulder arthroplasty: n = 7; RTSA: n = 2; mixed: n = 9) were analyzed. Delayed rehabilitation after RTSA improved early pain scores (ASES pain 26.3 ± 16.3 vs. 16.7 ± 11.6 at 6 months; P = .01) and overall function (ASES total 40.2 ± 20.1 vs. 30.0 ± 18.8; P = .04), without affecting long-term outcomes (ASES 88-90, SST 9.8-9.9, SANE 85-88 at 12 months). Opioid-sparing and opioid-free protocols achieved equivalent functional recovery (ASES 74-89, SST 6-9, SANE 24-28 change-from-baseline) and consistently higher patient satisfaction (86-97%) at 2-6 weeks. Continuous interscalene blocks and liposomal bupivacaine provided effective analgesia (Quality of Recovery-15 postoperative day 3: 124.5-132.0), with trends toward improved early recovery. Across studies, range of motion outcomes (forward flexion 126-146° and external rotation 57-62°) were comparable, indicating multiple enhanced recovery after surgery strategies can deliver similar functional and patient-reported outcomes while enhancing early recovery and satisfaction.
Conclusion
Functional recovery following shoulder arthroplasty appeared robust across diverse rehabilitation and analgesic strategies. Delayed rehabilitation offered early pain advantages, and opioid-sparing approaches enhanced patient satisfaction without compromising outcomes. These findings supported a personalized, patient-centered approach to postoperative care and highlight the need for further high-quality comparative trials.
Date Issued
2026-08-01
Date Acceptance
2026-03-06
Citation
JSES Reviews, Reports, and Techniques, 2026, 6 (3), pp.2666-6391
ISSN
2666-6391
Publisher
Elsevier
Start Page
2666
End Page
6391
Journal / Book Title
JSES Reviews, Reports, and Techniques
Volume
6
Issue
3
Copyright Statement
Copyright This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
License URL
Publication Status
Published
Article Number
100725
Date Publish Online
2026-03-19