Characteristics of rheumatoid arthritis patients undergoing reverse shoulder arthroplasty.

Abstract

The risks and complication profile of reverse total shoulder arthroplasty (RSA) in rheumatoid arthritis (RA) patients has yet to be clearly defined as most studies have small cohorts. Using a large inpatient database, the purpose on our study was to determine the overall demographics, hospitalization characteristics, and early complication rates in rheumatoid patients and compared these to rotator-cuff arthropathy patients without RA undergoing RSA. Utilizing United States Nationwide Inpatient Sample from 2010 to 2013, we evaluated a total of 919 RA RSA and compared them to 8097 patients without RA undergoing RSA. The outcomes included demographic characteristics like age, race, sex, Deyo comorbidity score, perioperative complications, and mean length-of-stay. The RA cohort had 81% females versus 60% in the comparison cohort. This cohort was younger (p=0.006) and had longer hospitalization time (p=0.001), but the total inpatient costs were not significantly different (p=0.15). In regards to Deyo index, rheumatoid patients had significantly higher scores (p<0.001). The inpatient complication rates for infection (p=0.9), nerve injury (p=0.9), and instability (p=0.19) were similar, but the RA cohort had more prosthetic-related (p=0.001) and greater tuberosity-related (p=0.008) complications. The mortality rates were also similar (p=0.625). In RSA for RA patients, surgeons should be mindful of preoperative risk factors and demographic characteristics that may influence their outcomes. Caution should specifically be paid to the possibility of longer hospitalization time and increased incidence of certain complications, including intraoperative fracture, when compared to non-rheumatoid patients. Close collaboration between rheumatologists, surgeons, and primary care physicians is a must for optimizing and managing these patients.