A worldwide cross-sectional survey seeks the current global practice patterns on perioperative management in elective shoulder replacement surgery

Background Perioperative management in elective shoulder arthroplasty varies widely, with no universal consensus on best practices. This study aimed to characterize current global standards of perioperative care, including preoperative, intraoperative, and postoperative management, among orthopaedic surgeons performing elective shoulder replacement surgery, with the aim of contributing to a global standard of care. Methods A comprehensive online questionnaire was designed and anonymously distributed to Orthopaedic Societies on each continent. Participants were cross-sectionally surveyed with the goal of identifying current global preoperative, intraoperative and postoperative practices in patient care and discharge management. Results Eighteen societies from 5 continents participated in the survey. A total of 977 orthopaedic surgeons completed the online questionnaire. The data analysis reveals that routine preoperative advanced imaging studies are not standard with either CT scan (50%) or MRI scan (39%) preferred. Preoperative planning software was not routinely used (31%). A chlorhexidine wash is part of the pre-surgical preparation for 52% of participants, but 23% do no pre-wash. Beach-chair or lazy beach-chair is the preferred surgical position (99%), and the deltopectoral approach remains the most standard approach (91%). Perioperative antibiotic use is nearly universal (99%), whereas routine tranexamic acid (TXA) use remains moderate (43%). Postoperative sling use varies from 4-6 weeks including ROM restrictions. Same-day surgery accounts for only 4% of discharge practices, while 32% discharge on the first postoperative day. Sixty-four percent of respondents discharge patients after several in-hospital nights. Conclusion Survey data show marked homogeneity in intraoperative practices (e.g., surgical approach, patient positioning, and antibiotic use). However, preoperative and postoperative survey results, including planning software use, postoperative immobilization, and discharge times, showed substantial variation. These findings highlight the need for further research and consensus to establish evidence-based perioperative protocols in elective shoulder replacement surgery.