Does morbid obesity negatively impact perioperative outcomes following elective reverse shoulder arthroplasty?: a propensity-matched comparative study

Abstract

BackgroundThe incidence of primary reverse total shoulder arthroplasty (rTSA) and the prevalence of obesity have increased in the United States. Despite this, the literature assessing the effect of morbid obesity (body mass index (BMI)≥40 kg/m2) on perioperative surgical outcomes remains inconsistent. MethodsA retrospective review of consecutive elective primary rTSA cases from January 2016 through September 2023 at a single tertiary referral center was performed. All cases involved a short-stem humeral component and screw-in glenoid baseplate from the same implant manufacturer. Surgical and patient demographic data were collected. Morbidly obese patients were propensity matched at least 1:1 with non-morbidly obese patients based on age, gender, mFI-5 score, ACCI score, and 12-month preoperative ED visit. Regression analysis was utilized to assess the relationship between morbid obesity and operative time, LOS, ITVBL, surgical postoperative complications, in-hospital medical complications, disposition, and 90-day ED return and readmission. ResultsThere were a total of 175 short-stem rTSA cases performed with a median age of 71 years (IQR 66,76) and of which 19 (10.9%) had a BMI≥40 kg/m2. These 19 patients were propensity score matched to 41 non-morbidly obese patients (9 at 1:3, 4 at 1:2, and 6 at 1:1). There were no significant differences between the groups with regards to ITBVL, operative time, need for transfusion, hospital LOS, discharge disposition, prevalence for 90-day return to ED, or unplanned 90-day readmission. ConclusionsMorbid obesity should not be considered an absolute contraindication for elective rTSA, particularly in patients who have undergone appropriate preoperative medical clearance.